Research Assessment#1
Analysis:
At the Cedars-Sinai Heart Institute, researchers infused
antibody-studded iron nanomedicine into the bloodstream of laboratory rats in
order to regenerate heart muscles injured by heart attacks. The combined
nanomedicine enables the body’s own stem cells to localize and treat the
injured heart muscle. However, there’s no guarantee that the stem cells will be
able to travel to the injured heart muscle and work collaboratively with the
present cells to fix the issue.
The author states that “antibody-studded iron nanoparticles”
are infused within a patient. Paying close attention to the how specific the
nanomedicine that the researches use helps shows us that the heart is a complex
organ, and in order to repair the heart only certain efficient medicine can be
used. Cardiology pertains about the tiniest of details, so skewing away in even
the slightest direction can impede one from succeeding. Every detail and
attribute is important and essential in cardiology.
The “molecular matching” researches must do in order to
succeed in regenerating the heart muscle takes a lot of hard and dedicated
work. Combining and separating molecule from molecule requires lots of trial
and error, which shows that cardiology is no simple task. The researchers will
fail numerous times with trial and error, but the failure does not mean that
they should quit. Rather the failure means that they should work harder and
harder since they’re becoming closer and closer towards success. I know that I
will face much adversity while I study cardiology, but that doesn’t mean that I
should quit since overcoming those barriers would make me stronger and more
knowledgeable than ever.
The “significant reduction” of the size of scars on the heart
muscles of some heart attack patients shows that nothing is impossible. Even
though the heart may pump the nanomedicine targeted stems cells away from it,
the researchers found a procedure to enable some of the stem cells to reach the
targeted location of the heart injures. The specific procedures attempted by
the researchers proved to work and now the patients who received the treatments
become more joyful and thankful. Nothing is better in the medical world than
seeing the delighted expression of patients who have been cured of their
problems. The benefits of cardiology are the memories one can make with his patients
and the appreciation he receives from that.
The year “2009” shows that Dr. Eduardo Marban, the director
of the Cedars-Sinai Heart Institute, has worked on his goal of developing a
nanomedicine cure for many years.This shows that without patience the iron
nanoparticle concept wouldn’t have become a close reality that treats patients
from heart attacks and cures heart tears or scars. Cardiology requires a lot of
patience since it takes many years to become a cardiologist. Patience is the key
to succeeding in anything.
After reading this article I
understand now that even the smallest details matter. When I study cardiology
in the near future I will remember to pay close attention to almost every
detail I can. I feel that cardiology is right for me
since I know that I won’t quit after becoming obstructed by obstacles, rather I
will overcome those problems and succeed. I am patient and dedicated enough to
reach my goal.
Analysis:
At the UT Southwestern Medical
Center, researchers have found that certain proteins promote or hinder a
healthy cardiovascular system. The common variant circulating protein
apolipoprotein E, called apoE3, helps repair the lining of blood vessels, while
the genetic variant apoE4 doesn’t thus increasing the chance of cardiovascular
disease for those individuals who have this protein. Researchers have found
that unlike apoE3, apoE4 cannot activate endothelial cells to produce nitric
oxide (NO), a molecule that helps eliminate a variety of vascular disorders.
The researchers state that “apoE3 binds to receptor ApoER2”
and together “they act on endothelial cells, which are the guardian cells of
blood vessels” to produce nitric oxide that enhances reparative and anti-inflammatory
processes. Paying close attention to how the protein and the receptor work
jointly and productively help show us that in order to foster a healthy
cardiovascular system every molecule must work dependently and accordingly. For
instance, if apoE3 doesn’t bind to receptor ApoER2 then inflammation in the
heart occurs, and the process then contributes to vascular disorders, which is
detrimental. The way the protein and the receptor cooperate with one another
helped me to understand that in the medical field cooperation and thoroughness
is needed to succeed.
The “potential preventive treatment” for cardiovascular
diseases in patients who have the apoE4 shows just how deleterious the variant
is. Only a few months after successfully finding out about apoE4, researchers
conducted experiments for treatments, which show the increased risk of
cardiovascular diseases due to the protein. The severity of the protein cannot
be undermined. Because researchers took charge of the situation, individuals
can now benefit from treatment with an NO donor. This shows that nothing should
be taken lightly since many things can be injurious to one’s health even though
one might not know so.
ApoE4 “prevents” the actions of apoE3, which explains why
individuals with one copy of apoE3 are still at a great risk of vascular
disease. This shows that there are many molecules that can hinder the health of
the heart, and it is the duty of a doctor to help ensure that his patient is
free from these hindrances. Even though one thing might hold back another, one
should never give up since there can always be a way to help.
Even though there is a considerable understanding of the
apoE-ApoER2 tandem in the central nervous system and in Alzheimer’s disease,
the impact of the their cooperation in the cardiovascular system is nebulous.
This means that the complex is unknown by many who are researching the
cardiovascular system. There are new findings on the apoE and ApoER2 complement
every week. This shows that there are many unknown research that can be
conducted on the cardiovascular system and the heart, and that the
possibilities and information about cardiology is endless.
After reading the article I understand that cardiology is a
field in which will not be dull or monotonous since new knowledge and
intelligence about it can surface up. I also understand that just like
molecules that work together to create a beneficial process, I should work
dependently and be more involved with others in the future when I’m in the
medical field since it could help me further my learning than I could ever
independently. I understand ultimately that cardiology is a field in which I
should be serious and should not take lightly if I want to succeed.
Analysis:
At NYU Langone Medical Center, cardiovascular
scientists and researchers have found that a certain protein acts as a
regulator for the heart’s rhythm. This newly identified protein known as Pcp4
allows the heart to beat at a normal and steady rate, away from any risks of
cardiovascular troubles and problems. However, when the Pcp4 protein becomes
disrupted then ventricular arrhythmias can occur. These arrhythmias are
irregular heartbeats, such as when the heat beats either faster or slower than
usual, causing the heart to become damaged and weakened.
When
the researchers tested the effect of the “Purkinje cell protein-4” (Pcp4) on
mouse experimental models, they found that the protein is not only important in
maintaining the heart’s normal rhythmic behavior, but can also prevent cardiac
arrhythmias when in appropriate amounts. However, when Pcp4 expression is
reduced then it “short circuits” electrical activity in miniscule yet critical
populations of cells within the heart muscle, affecting the proper way the
heart ultimately beats. Paying close attention to how the protein affects other
cells within the heart helps show that mostly everything is connected and
intermingled within the heart. Just one small error can lead a disastrous
effect to the heart, which shows that even in life one careless mistake can be
detrimental to one’s future. The actions of the protein helped me understand that
I must be extremely cautious when in the medical field since for the patient
it’s either life or death situation.
Professor William Goldring stated that there
would be “increased morbidity and mortality” when Pcp4 expression is abnormal,
resulting in ventricular arrhythmias and sudden cardiac deaths. Essentially,
this means that just one protein can initiate horrid effects to the heart system.
Consequently, one single action can take a toll on my life and future, meaning
that mistakes are quite critical. The way in which the professor expresses the
terrible effects helped me understand the severity of the situation and how I
must be cautious of things that I overall do.
Furthermore, the NYU researchers were not
dismayed when they learned that Pcp4 expression was “down-regulated” in
diseased hearts, producing critical heart abnormalities that increase the
people’s susceptibility to arrhythmias. Instead, they were reluctant since they
could now create and synthesis portent drugs that target the protein, thus
being capable of treating arrhythmias.
Dr. Glenn Fishman stated that drugs that mimic Pcp4’s action in the
heart could potentially “stabilize” the heart’s system. The remarks made by the
doctor were both positive and elated, creating a hopeful tone as the protein
that could be even pernicious on occasions would help treat patients who have ventricular
arrhythmias. The doctor’s statements helped me realize that there would always
be light in darkness, showing that even though someone might find himself among
great adversities, he will always find a path towards hope.
Instead of taking light of finding the new
Pcp4 protein, researchers were making use of its identification to the fullest
potential as they initiated research and drugs to cure patients with
arrhythmia. This shows that a lot of hard work and effort is placed to help the
patients further improve their health. I understand that the field of
cardiology is no joke and that to succeed I must truly push myself and work to
my fullest extent.
After reading the article I understood that
millions of Americans suffer from arrhythmias alone, while millions more suffer
from various other cardiovascular diseases. This shows that for a cardiology,
let alone any professional, a patient’s happiness is the key towards success of
the doctor, and it is his full responsibility to fulfill their wishes. Also,
there is much more to learn about the heart since researchers’ state that there
is a vast amount of knowledge unknown about the “molecular behavior” pertaining
to arrhythmias. This shows that cardiology is not a monotonous field since new
knowledge can be attained anytime. Also, I understand that in the medical field
there will always be ups and downs, but I have to overcome the struggles in
order to be successful.
Analysis:
According to a new study by
researchers at the Intermountain Medical Center Heart Institute in Salt Lake
City, heart attacks are not as connected to family history and genetics as may
have been previously assumed. This new information helps individuals with a
family history of coronary disease and narrow coronaries understand that heart
attacks aren’t inevitable and that the lifestyle choices they make along with
the environment factors determine whether or not they would have heart attacks.
Instead of blaming genetics for their coronary disease, citizens must now alter
their daily tasks in order to prevent themselves from severe heart attacks.
Benjamin D. Horne, PhD, MPH,
director of cardiology and genetic epidemiology at the Intermountain Medical
Center and his research team conducted a study of patients with varying
severities of coronary disease who may or may have not suffered from a recent
or past heart attack. Even though severe coronary artery disease can be
inherited regardless of whether someone has a heart attack, the presence of
heart attacks in people with less severe coronary disease was not “clustered”
in families. The research team evidently compared heart attack patients to
registry people with coronary disease who were “free” from heart attacks. This
shows that cardiology and likewise other fields are constantly revolving with
new information being found every so often. The article has simplistic diction
and form so that the readers who may or may not be scientists can understand
that the situation isn’t pernicious or dire. They now know that if they can
alter their habits then they can prevent themselves from heart attacks.
Dr. Horne stated that “because
coronary disease and heart attacks are so closely related, researchers in the
past have assumed they’re the same thing”, however, this finding may help
people realize that through their choices they have greater control over
whether they ultimately have a heart attacks. This shows that not everything in
science is set forth and true, since the assumption of coronary heart disease
relating to heart attacks was proven wrong recently. Science is ever so changing
and scientists must make good use of that change. With these new findings,
researcher can now look for triggers or risk factors for heart attacks that
result from behavior or environmental factors rather than genetic ones.
Researchers now don’t have to waste their time on pointless studies and can now
orient towards what’s needed. This shows that through diligence and
perseverance, the researchers were able to successfully find useful information
that they can now use to conduct their new studies without the worry of any
errors.
The research team found that the
genetic factors related to chromosome 9 were strongly “connected” to coronary
disease but had no “connection” to heart attacks. The use of the word “connect”
shows that not scientists and likewise normal individuals assumed that
everything within the human body was connected in one way or another. However,
we now understand that even though the there might be some slight “connection”,
everything within the heart attacks, such as proteins, mutations, and factors,
are independent from one another. This helps me to understand that in the
medical environment in order for me to progress as an individual I have to
become more independent, since being “connected” to people all the time will be
detrimental in my learning.
The knowledge achieved from the
study can now help people wide-spread and world-wide in order to avoid any
health risks and improve their quality of life. Yet again I understand that
cardiology and science overall are quite dynamic. There will always be new
findings and new ideas that revolutionize the way we think. From this I
understand that I must be learn from the changes and adapt my way of life since
nothing is always the same. Also, I understand that dependence upon others
would be pernicious for my progress within medicine since being “connected”
with people every moment will hinder my learning and my capability to be
independent when I become a doctor in the future. Furthermore, I understand
that I must be diligent while pursuing in the field of medicine since it would
not be a facile path. When entering the medical field, like that of the
researchers, I must be serious and affectionate to what I do.
Analysis:
The heart is a muscular organ that
weighs just seven to fifteen ounces, pumps roughly two thousand gallons of
blood throughout the body every day, and functions as the body’s circulatory
pump. Deoxygenated blood travels through the veins into the heart and is
delivered to the lungs for oxygenation before being pumped out into the various
arteries that stem from the heart. These arteries provide oxygen and nutrients
to body tissues as they transport the oxygenated blood throughout the body.The
heart sits within a fluid filled cavity called the pericardial cavity, where
the walls and lining contain a special membrane known as pericardium. The
pericardium serves to hold the heart in position and allows for a hollow space
so that the heart can expand when it is full.
The structure of the heart wall is made up of three layers:
the epicardium, the myocardium, and the endocardium. The epicardium is the
outermost layer of the heart wall and is made up of a thin layer of serous
membrane that helps to lubricate and protect the outside of the heart. The
myocardium is the muscular middle layer of the heart that makes up the majority
of the thickness and mass of the heart wall. Also, the myocardium is the part
of the heart that is responsible for pumping the blood. Lastly, the endocardium
is the simple endothelium layer that lines the inside of the heart. The
endocardium is very smooth and is responsible for keeping the blood from
sticking to the inside of the heart, thus preventing potential deadly blood
clots.
The heart contains four chambers:
the right atrium, the left atrium, the right ventricle, and the left ventricle.
Compared to the ventricles, the atria are smaller, thinner, and less muscular
walls. While the atria act as receiving chamber for the blood since they are
connected to the veins, the ventricles act as large, strong pumping chambers
that send blood away from the heat since they are connected to the arteries.
The right side of the heart is smaller compared to the left side of the heart
since the right side of the heart maintains pulmonary circulation to the nearby
lungs while the left side of the heart pumps blood all the way to extremities
of the body in the systemic circulatory loop.
With regard to their specific
functions, the right atrium collects deoxygenated blood returned from the body
while the left atrium collects oxygenated blood returned from the lungs. When
the heart contracts, the right ventricle pushes the blood into an artery that
leads to the lungs where the blood will then be oxygenated before it returns to
the heart. The left ventricle is the largest and strongest of the four chambers
since it must be forceful enough to push the blood into the body’s blood vessels
for circulation though the body. All together, the septum, a thick muscular
wall that runs down the middle of the heart, separates the left atrium and
ventricle from the right atrium and ventricle.
The valves separate the multiple
parts of the heart from one another. They allow and prevent blood from entering
certain places of the heart. The mitral valve separates the left atrium and the
left ventricle, while the tricuspid valve separates the right atrium from the
right ventricle. The aortic valve lies between the left ventricle and the
aorta, which leads to the body’s network of blood vessels while the pulmonary
valve lies between the right ventricle and the pulmonary artery, which leads to
the lungs. These valves open and close in response to pressure change within
the various parts of the heart.
From this article I have learned
that the heart functions simultaneously to keep blood moving though the body.
The heart is truly essential for our health and wellbeing since it represents
the foundation for which we live off of. I have also learned from the knowledge
attained from learning about the anatomy and functions of the heart that
Cardiology is not a field in which one can pursue into with lackluster since
extreme dedication and diligence must be needed. The structures and functions
of the heart are intricate, so the field of Cardiology will also be quite
complex and difficult. Additionally, I learned that the heart is a fragile
organ that requires delicate care. The responsibility of Cardiologists is to
nurture the hearts of those who have cardiac problems since without the heart
nothing can continue to progress on.
Analysis:
According to a Kaiser Permanente
Medical Santa Clara Center study, the commonly used drug Digoxin that normally
is used to treat heart conditions was found to be associated with a high chance
of deaths. He found that the drug caused seventy-one percent higher risks of
deaths and sixty-three percent higher risks of hospitalization among adults
with diagnosed atrial fibrillation and without any evidence of heart failure.
Since over a century, the drug
Digoxin has been used to control the heart-rate of patients with atrial fibrillation.
Even today the drug is recognized specifically for this distinct purpose
worldwide. When sedentary patients need a resting heart-rate control, current
clinical practice guidelines highly recommend the use of Digoxin for the
management of atrial fibrillation. However, from the new information that
surfaced up this drug could be pernicious to the patients instead. This shows
that the medical society hasn’t really touched into the details of the
procedures and drugs that they have been using. This occurs because they most
likely don’t have any information on the topics, which shows that the medical
world is still new and developing. There is much more knowledge that we can
attain.
The Chief of Cardiology at the
Kaiser Permanente Santa Clara Medical Center, Dr. Anthony Steimle, states that
“the use of Digoxin should be re-evaluated” for the treatment of atrial
fibrillation in contemporary clinical practices. He emphasizes that the heart-rate
control for the management of atrial fibrillation can controlled with other
viable available options. Results show that Digoxin was associated with a
seventy-two percent higher rate of death among adults with newly diagnoses
systolic heart failure. The study showed the detrimental effects that rose from
the drug and the caution needed to take place with the drug. The statement by
Dr. Steimle shows that further research should have been conducted before
allowing the drug to be used in clinical practices. This proves that the
medical world has much more room to advance as there is much knowledge that can
be learned.
The study showed that there should
be guiding clinical cardiology decision-making in regard to Digoxin and other
drugs in the modern era. As the medical society learns more and more
information that could enhance the procedures and drugs proceeded today, they
should reconsider the use of past ideas since everything is just advancing now.
New technology, new drugs, and new procedures are being taken place every year
so the medical society much take into consideration the thoughts of past and
re-evaluate these ideas. I have also learned that cardiology is not a stable
field which means that new information can arise at any moment. The new knowledge
that surface up doesn’t mean that the past ideas are wrong but instead means
that past ideas should be taken into consideration with the current ones.
Analysis:
Sixty-eight year old Margaret Mann
was the first to have a minimally-invasive procedure to replace her leaking
mitral valve after she was deemed unsuitable for an open heart surgery. Mann’s
condition known as mitral regurgitation causes her shortness of breath,
tiredness, dizziness, and chest pain, which impedes her from accomplishing her
daily routine and tasks. The condition occurs when the mitral valve, which
separates the upper left heart chamber from the lower left chamber and helps
control blood flow though the heart, becomes damaged and fails to close
properly. This results in blood flowing backwards and leaking through the valve
when the heart contracts.
The Tendyne tissue valve can be
placed into a patient’s beating heart without the need for a cardiopulmonary
bypass, which is a heart-lung machine used for open heart surgeries. The valve
is implanted via a catheter through a small incision between the ribs. During
the procedure the device can be repositioned, removed, or redeployed as
necessary with much ease. The development for this procedure seems
extraordinary since the problem can be fixed without the need for an extra
excessive surgery which could deem detrimental to some patients.
According to Mrs. Mann the Tendyne
system has allowed her to be with her family for the first time. Before the
operation she wouldn’t have been well enough to cope with everybody under the
same roof, but the implantation changed that. Mrs. Mann was finally able to
spend an entire Christmas dinner with her whole family without having any such
problems. This shows that the Tendyne system has made an incredible impact upon
her life. The mitral valve implantation has completely changed the life of Mrs.
Mann as she is now able to do many tasks that that she couldn’t have before.
Seeing her response towards the operation shows that she deeply approves of the
implantation for others as well.
The Tendyne Transcatheter Mitral
Valve system implantation has become groundbreaking in the medical world as
elderly patients can now become treated for mitral regurgitation without the
need for mitral valve surgery. Although mitral valve surgery would be the
recommended treatment for severe mitral regurgitation, patients who are not
suitable for surgery, due to the serious medical conditions that could arise
from open heart surgery, now have an option to attempt to relieve their
symptoms. The Tendyne system can only be used with patients who have primary
mitral regurgitation, in which something is structurally wrong with the mitral
valve. I believe that the Tendyne systems provide a very useful intervention in
the treatment of patients with mitral regulation. With success the Tendyne
system improves the quality of life of patients and potentially even extends
the lives of the patients with these complicated mitral valve disease.
Analysis:
According to research from Queen Mary
University of London, a revolutionary device has been shown to significantly
lower blood pressure among patients with uncontrolled high blood pressure
compared to those treated with usual drug measures. The device developed my ROX
Medical and named the Coupler is a paper clip sized implant which is inserted
between the artery and vein in the upper thigh. The entire procedure lasts
around 40 minutes under local anesthetic.
Patients who receive the Coupler
experience a significant and durable reduction in blood pressure, hypertensive
complications, and hospital admission for high blood crisis crises. The Coupler
also works well among patients who had failed to respond to renal denervation,
another new approach to treating high blood pressure, which suggests that the
Coupler targets different mechanisms of blood pressure control. Patients who
had not previously been treated with renal denervation experience the same
level or more of blood pressure reduction. Unlike denervation, this new
device-based treatment is fully reversible, immediate, and pain free.
Dr. Melvin Lobo, the Lead Author and
Principal Investigator of the study at Queen Mary University of London and
Director of the Darts Blood Pressure Clinic at Barts NHS Trust, states that "this is an entirely new and highly promising concept in high blood
pressure treatment. Existing drugs focus on hormonal or neurological regulation
of blood pressure, and newer treatments such as renal denervation are uniquely
centered on the renal nervous system. The Coupler effectively targets the
mechanical aspects of how blood circulation works - so it's a totally new
approach to controlling blood pressure. The Coupler also highlights the
importance of arterial stiffness as a major cause of resistant high blood
pressure and it targets this issue both safely and successfully. Once the
Coupler is placed, the results are also immediate, which again is unique to
this treatment.”
The
study findings show that blood pressure treatment with the ROX Coupler can give
patients and doctors an alternative option for treating high blood pressure in
the future, particularly when standard therapies have failed. The study has
also put the spotlight on how dangerous uncontrolled high blood pressure really
is. During the study there were five hospital admissions for hypertensive
crises among the control group and none in the Coupler group. However, the Coupler,
like all therapies, did have a side effect. Around twenty-nine percent of
patients who received the Coupler did go on to develop leg swelling which mean
another short term procedure was needed to deal with this, usually a stent in
the vein.
Analysis:
The ageing of
society needs new, more cost-effective solutions to improve the life quality of
patients and cut the burden that is placed on the social welfare system. In
modern western societies the fitting of pacemakers and implantable
cardio-verter defibrillators (ICDs) is growing rapidly. Devices of this type
control heart rhythm and, if necessary, send an appropriate response to make
the heart beat at the right rhythm. They also record heart activity patterns
when abnormal heart rhythm is detected. This information is periodically
checked and monitored by a doctor to plan future treatment. To do this, the
information is transmitted in wireless mode to an external device. At the moment
this communication is carried out in hospitals.
The
main manufacturers of pacemakers and DCIs have started to market remote
management devices. The remote monitoring of implantable, wireless medical
sensors is a constantly advancing field which nevertheless still has clear
shortcomings. The direct connection of medical sensors to the Internet is the
next natural step in this evolution, and will enable doctors to obtain the
information stored by the sensors at any moment and from any device connected
to the Internet. Despite its great potential, the success of a monitoring
system of this type is determined, among other things, by the protection of the
privacy of the information transmitted. A researcher in the UPV/EHU's
Department of Communications Engineering has developed the Ladon security
protocol, an efficient mechanism to authenticate, authorize and establish the
end-to-end keys (keys for communication between the terminal used by the doctor
and the patient's device), which offers revolutionary features for sensors of
this type.
Apart from its
application in the remote monitoring of medical sensors, all the checks carried
out in relation to the protocol lead to the conclusion that this is a protocol
to authenticate, authorize and set up the keys that is right for use even in
the securing of critical applications from the point of view of delay, like
remote surgery, for example. In any case, the possibility of marketing this
protocol for these purposes is still a long way off, as validations would have to
be conducted on real pacemakers. "We have carried out our validation on a
commercial sensor, not on a real pacemaker," said the researcher. In other
words, "one would have to conduct studies using real medical sensors and
real patients," explained Astorga. "In any case, we believe that it
is a step forward down the road along which the remote monitoring of patients
using implanted medical sensors can go on advancing."
