Surgical Trauma Course

http://cine-med.com/index.php?id=ATOM01

Advanced Trauma Operative Management

Lenworth Jacobs, Stephen Luk

Product Details

Product ID:	ATOM01
Year Produced:	2010
Length:	310 pages
Dimensions:	8.625x11 in
ISBN:	978-1-880696-48-4

Order Product

Book:	$200.00
CD-ROM:	$85.00
Book and CD:	$250.00
Book and CD:      Resident Price:*	$175.00
*proof of residency is required

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This 2nd edition is completely updated with new procedures, illustrations and expert tips on atypical, complex trauma casesdesigned for trauma surgeons encountering atypical, complex trauma cases. More than 50 international master trauma surgeons have collaborated to share their personal experiences in safely managing penetrating operative trauma.

About the ATOM Course

The Advanced Trauma Operative Management (ATOM) course is an effective method of increasing surgical competence and confidence in the operative management of penetrating injuries to the chest and abdomen.

The course consists of six 30-minute lectures followed by a three-hour lab session during which the student will manage 12 different injuries.

Testimonials
"I recently managed a young man with a posterior right arterial gunshot wound with tamponade and exsanguinating bleeding. I used the invaluable princples in 'Tips from the Masters' to control the hemorrage and repair this challenging wound. My patient went home in seven days and has subsequently returned to work."

Glen Tinkoff, MD, FACS
Senior Trauma Surgeon
Christiana Hospital

"Every surgical resident in the country should have this book."

Susan Briggs, MD, FACS
Associate Professor of Surgery
Harvard Medical School
Massachusetts General Hospital
Boston, MA

Table of Contents

• Chapter One
• Trauma Laparotomy
• Tips from the Masters
• Chapter Two
• The Spleen and Diaphragm
• Tips from the Masters
• Chapter Three
• The Liver
• Tips from the Masters
• Chapter Four
• The Pancreas and Duodenum
• Tips from the Masters
• Chapter Five
• The Urinary System
• Tips from the Masters
• Chapter Six
• The Cardiovascular System
• Tips from the Masters
• Chapter Seven
• Evaluation

Tips from the Masters

Each Chapter includes Tips from the Masters written by leading trauma surgeons.

Over 90 topics include:

• Abdominal Closure in the Damage Control Procedure
• Sigmoid Colon Laceration
• Distal Colorectal Irrigation
• A FAST Examination for Thoracoabdominal Injuries
• Exposure and Management of a Grade V Shattered Spleen
• Stab Wound to Lower Pole of Spleen
• Management of Major Hepatic Trauma
• Hepatic Vascular Exclusion
• Partial Pancreatic Transection
• Penetrating Duodenal Injury to the Second Portion of the Duodenum
• Stab Wound to the Pancreas with Ductal Injury
• Exposure and Management of a 3cm Burst Laceration of the Bladder
• Nephrectomy with Laceration of the Renal Artery and Vein
• Ureteral Repair
• The Mattox Maneuver
• Exposure in Management of an Atrial Laceration
• Gunshot Wound to the Abdominal Aorta
• Repair of the Inferior Vena Cava
• Celiac Trunk Injury
• Exposure and Repair of the Celiac Trunk and/or Superior Mesenteric Artery

CD-ROM Contents

Note, the contents of the ATOM companion CD-ROM have not changed with the 2nd Edition of the text.

The CD-ROM includes specially produced, operative video, narrated by Lenworth Jacobs, MD, coinciding with the ATOM course, including:

• Damage Control Procedures
• Diaphragm
• Stomach
• Liver
• Duodenum
• Kidney
• Ureters
• Bladder Repair
• Spleen
• IVC
• Retrohepatic IVC Isolation
• Right Media Rotation
• Pyloric Exclusion - sutured
• Pyloric Exclusion - stapled
• Pyloric Exclusion - ligated
• Small Bowel Anastomosis
• Roux-en-Y Pancreatico-enterostomy
• Gastroenterostomy
• Distal Pancreatectomy - Stapled
• Distal Pancreatectomy - Sutured
• Heart injuries
• Cadaver Dissection
• Supraclavian exposure
• Medial claviculectomy
• Lateral neck exploration
• Aorta and left subclavian
• Distal aorta and esophagus
• Aorta and proximal great vessels
• Clinical Scenarios to test your trauma decision making
• Penetrating Trauma
• Blunt Trauma

Sample Pages

Also Available

• ACS Video Anthology Collections: Trauma I: Abdominal Trauma
• ACS Video Anthology Collections: Trauma II: Thoracic and Diaphragm Trauma
• ACS Classic Collections Volume 7: Trauma
• ATOM Course Materials
• ATOM Course Student Manual

Pulse-Ox Meters- How they really work

Pulse-Ox:
  http://en.wikipedia.org/wiki/Pulse_oximetry

Near-Infrared Spectrum Based Meters:
   http://en.wikipedia.org/wiki/Pulse_oximetry

Carbon Monoxide Poisoning Pulse-Ox Meter:....sweet!! Determines poisoning levels from visualizing different hemoglobin carrying groups
   http://en.wikipedia.org/wiki/CO-oximeter

Massimo -Maker of CO-Meter
   http://www.masimo.com/rad-57/

Facial Tumor Surgery

http://www.youtube.com/watch?v=47uFqQ1H1gg

Elite Athlete Brain Structural Advantage

http://www.scientificamerican.com/article.cfm?id=olympics-insula-gives-edge

A Single Brain Structure May Give Winners That Extra Physical Edge

An extraordinary insula helps elite athletes better anticipate their body's upcoming feelings, improving their physical reactions

By Sandra Upson  | July 24, 2012 | 1

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Winning in the OlympicsWhat separates a champion from the rest of the pack? Science has some compelling answers »July 24, 2012

Image: Don Sutherland, U.S. Air Force, via commons.wikimedia.org

What a Plant Knows

How does a Venus flytrap know when to snap shut? Can it actually feel an insect’s tiny, spindly legs? And how do cherry blossoms know when to bloom? Can they...

Read More »

All elite athletes train hard, possess great skills and stay mentally sharp during competition. But what separates a gold medalist from an equally dedicated athlete who comes in 10th place? A small structure deep in the brain may give winners an extra edge.

Recent studies indicate that the brain'sinsular cortex may help a sprinter drive his body forward just a little more efficiently than his competitors. This region may prepare a boxer to better fend off a punch his opponent is beginning to throw as well as assist a diver as she calculates her spinning body's position so she hits the water with barely a splash. The insula, as it is commonly called, may help a marksman retain a sharp focus on the bull's-eye as his finger pulls back on the trigger and help a basketball player at the free-throw line block out thedistracting screams and arm-waving of fans seated behind the backboard.

The insula does all this by anticipating an athlete's future feelings, according to a new theory. Researchers at the OptiBrain Center, a consortium based at the University of California, San Diego, and the Naval Health Research Center, suggest that an athlete possesses a hyper-attuned insula that can generate strikingly accurate predictions ofhow the body will feel in the next moment. That model of the body's future condition instructs other brain areas to initiate actions that are more tailored to coming demands than those of also-rans and couch potatoes.

This heightened awareness could allow Olympians to activate their muscles more resourcefully to swim faster, run farther and leap higher than mere mortals. In experiments published in 2012, brain scans of elite athletes appeared to differ most dramatically from ordinary subjects in the functioning of their insulas. Emerging evidence now also suggests that this brain area can be trained using a meditation technique called mindfulness—good news for Olympians and weekend warriors alike.

Peak performance
Stripped of the cheering fans, the play-by-play commentary and all the trappings of wealth and fame, professional sports reduce to a simple concept: The athletes who enthrall us are experts at meeting specific physical goals. They execute corporeal feats smoothly, without wasting a single drop of sweat.

Such performance is a full-brain phenomenon. The motor cortex and memory systems, for example, encode years of practice. Nerve fibers become ensconced in extra layers of a protective sheath that speeds up communication between neurons, producing lightning-fast reflexes. Understanding the brain at its athletic best is the goal of psychiatrist Martin Paulus and his colleagues at the OptiBrain Center. They propose that the insula may serve as the critical hub that merges high-level cognition with a measure of the body's state, to insure proper functioning of the muscles and bones that throw javelins and land twirling dismounts from the high bar. "The key idea we're after is how somebody responds when they get a cue that predicts something bad will happen," Paulus says. "The folks that are performing more optimally are the ones who are able to use that anticipatory cue to adjust themselves and return to equilibrium."

108 year old Teaching Gratefullness

Learning gratefulness in small things to help you live to be 108.
Take your daily life in the rat race and throw it out the window, think differently.

Video: 108 Year-Old Holocaust Survivor Explains Being Grateful

At age 108, Holocaust survivor Alice Herz Sommer still practices piano for 3 hours every day. At age 104, she had a book written about her life: “A Garden Of Eden In Hell.” At age 83, she had cancer. Alice survived the concentration camps through her music, her optimism and her gratitude for the small things that came her way – a smile, a kind word, the sun. When asked about the secret of her longevity, Alice says: “I look where it is good.”

Video from KarmaTube

Seeing Color-Eyeborg....cool

http://www.ted.com/talks/neil_harbisson_i_listen_to_color.html

Diagnostic Tools for the Poor

http://www.ted.com/talks/vinay_venkatraman_technology_crafts_for_the_digitally_underserved.html

Medical Emergencies Example Videos

Flailed Chest:  from chest hitting steering wheel inside a car
  http://www.youtube.com/watch?v=uJHfX1RFkF0

Real CPR Rescues at Bondi Beach : Sydney
   http://www.youtube.com/watch?v=ICODRFoWZkw

Real Time Heart Attack-CPR + Save
   http://www.youtube.com/watch?v=rNJYCtbcLH4&feature=related

Flying Hospital Plane of US Army:
   http://www.youtube.com/watch?v=htiYVoZwLGE&feature=related

Childrens Cardiac Arrest:
   http://www.youtube.com/watch?v=jcPSqe-oxPM&feature=related

Killer Mosquito..cool!!..using genetic science for real solutions

Genetically modified mosquitoes fight dengue fever

Brazilian health authorities have taken the lead in the fight against dengue fevernot with vaccines but rather with mosquitoes. At the start of this week they expanded their program and opened a large-scale mosquito farm in the northeast state of Bahia.

Now, these are not the garden-variety mosquitoes, they are an army of genetically modified male mosquitoes being used to combat, rather than spread, disease. In the laboratory, male mosquitoes are genetically modified to carry a lethal gene against the dengue virus. They are then released into the wild to mate with female mosquitoes (who are actually the ones who bite humans – since they need the blood for their eggs) and once the lethal gene is passed on to the offspring they die in the larvae stage and never make it to adulthood.

The target is dengue fever, for which there currently is no vaccine, and prevention largely has failed.

The World Health Organization classifies dengue as a mosquito-borne viral infection that causes a severe flu-like illness and sometimes a potentially lethal complication called hemorrhagic dengue. Though data from the U.S. Centers for Disease Control and Prevention report transmission in the continental United States is mostly due to travel to sub-tropical and tropical areas in the world, data from WHO indicate the incidence of dengue has increased 30 fold over the last 50 years.

According to the latest World Health Organization statistics 50 million  to 100 million infections are now estimated to occur annually in over 100 endemic countries, putting almost half of the world’s population at risk.

In Brazil this year alone, the health ministry recorded 431,194 infections, with Rio de Janeiro leading in the number of cases. While the government of Brazil has attempted many other campaigns against the mosquitoes, Brazilian Health Minister Alexandre Padilha insists this new effort could be the answer to controlling the dengue epidemic in the country.

The farm in Bahia is a partnership between the Brazilian government and Moscamed, an agency that specializes in the production of transgenic insects for the biological control of pests. It uses research and methods developed by several Brazilian universities as well as by British company Oxitec. It will produce at maximum capacity around 4 million sterile males of the dengue-carrying mosquito Aedes Aegyptis per week.

Moscamed’s fact sheet on the project claims that since its beginning in February 2011 it has released more than 10 million male transgenics. This month over 95% of the larvae found in the two neighborhoods that served as test communities are already transgenic, or genetically modified to not reach adulthood, the agency says.

Though there is a lot of buzz about this alternative method of disease management, public health officials and environmentalists are skeptical and concerned about the long-term ramifications this could have. In a recent ongoing case in Key West, Florida, Oxitec was set to test a similar project in a 36-square-acre block near the Key West Cemetery. Officials of the Florida Keys Environmental Coalition sent Florida Gov. Rick Scott a letter detailing how they did not want to become “guinea pigs.”

“Despite the grave and growing public concerns that have been raised about the genetically engineered mosquitoes, there is no indication that the U.S. Food & Drug Administration or any other federal or state agency has evaluated the safety of the company’s planned release. Nor has there been an independent analysis to examine the public health or environmental impacts of this release,” the letter said.

In Brazil, Moscamed held talks with locals before the trial started. The agency also printed fliers explaining the process and sent representatives to schools to talk to the children. Dengue is a well-known fact in Brazil and so are the campaigns against it. Social media, television, day-to-day talk and such are dominated by anti-dengue slogans and campaigns launched by the government.

Scientists in Brazil are largely overseen by multiple government ministries and committees and, according to local media, residents in the areas were the trials are held are accustomed to the sights. Most of the interest comes from scientists and researchers worldwide who flock to Moscamed to learn about the benefits of the program.

According to a release by the state of Bahia, the project, paid for with funds from the state and federal government, cost about $1.6 million, and aims to control disease transmission. The state and federal governments also spend millions of dollars each year in campaigns to educate residents and to slow the procreation of mosquitoes. Brazilian researchers also work with the French Pasteur Institute in the development and trial of a vaccine against the virus.

"We will work to bring this technology to municipalities with higher levels of infestation, such as Jacobina and Itabuna, where it will be possible to analyze also in appropriate circumstances. Remember that we are still in research stage and are not routinely using the technique," said the state health secretary, Jorge Solla, in a press release announcing the new facility. After the testing phase, Solla says the project will be expanded.

Oxitec is also conducting testing in other countries. Its strand of the OX513A mosquito has regulatory approvals for import and contained (in lab) testing in Brazil, the Cayman Islands, France, India, Malaysia, Singapore, Thailand, the United States and Vietnam. Open field trials have taken place in both Grand Cayman and Malaysia, in a small scale.

Though all this may seem like a scene straight out of a science fiction movie, these genetically modified mosquitoes provide a window of hope for millions of people. The Brazilian health minister, Alexandre Padilha, said during the inauguration of the new facility that the Brazilian government will keep a close eye in this project, as well as the continued research into other avenues, and could use it as one more weapon in the fight against the disease.

HIV drug

Chemists have built molecules that flush out human immunodeficiency virus (HIV) hiding inside immune cells. While these compounds do not cure the virus that causes AIDS, they could be a powerful addition to current treatments, which cannot eradicate these dormant viruses.

Current HIV treatment requires a cocktail of drugs to kill viruses replicating in T cells, and patients must regularly take their medicine to keep the virus at bay. HIV can hibernate in these cells and reemerge to infect patients if they stop treatment.

Another approach to treating HIV aims to reactivate these dormant viruses, thereby allowing the immune system (or the virus itself) to kill the cells where they are hidden. In conjunction with cocktail therapies that keep HIV under control, this approach has the potential to completely purge the virus from a patient.

Once such potential drug, called prostratin, binds to a protein (protein kinase C) that helps reactivate hibernating viruses. Chemist Paul Wender, of Stanford University, first synthesized prostratin in the lab in 2008, and the compound is being considered for clinical trials.

Bryostatin 1, a compound produced by a marine organism, might be a useful HIV treatment, too, because it binds to protein kinase C better than prostratin. But there are several concerns about using it as a potential medicine. Bryostatin is hard to come by, both in nature and in the lab. And, perhaps most worrisome, bryostatin can cause negative side effects in humans.

Now Wender and his colleagues have built seven molecules related to bryostatin, two of which are about 1,000 times more effective at reactivating dormant HIV than prostratin. These molecules appear non-toxic in early cell tests.

These “bryologs” retain chemical groups important to the potency of bryostatin, yet their synthesis is streamlined enough that the scientists can make the bryologs on a large scale. The researchers build and connect molecular fragments to form an entire bryolog. That means they can potentially change reactive groups on the fragments to enhance each compound’s effectiveness while reducing negative side effects.

The scientists treated cells that model a latent HIV infection with each new bryolog. The new compounds reactivated dormant HIV at concentrations 25 to 1000 times less than current preclinical compound, prostratin.

The researchers are currently testing the bryologs in animals. They hope these new compounds could be used as part of a treatment that eliminates all HIV currently in someone's body, whether the virus is active or not. That could be one way to completely eradicate the virus, they add.

EMT class #2

Who ever said EMT classes are easy are rediculous. Everyone that has taken the class said it was simple, a cake walk, but many people are nearly failing in my class. Im studying my ass off every day, at least half the day. We are required to get 80% on ALL our tests, so there is alot of pressure to perform well.
Im working my butt off, doing everything I can to survive and learn stuff at near perfect level....so much for a summer, 2 summers in a row....I can barely enjoy the short lived good weather we're having.
No sleep for medical students.
I must say it is a very good intro level course that really bathes you by fire into the vastness and depth of medicine....like riding a rocket.
I recommend it to anyone that is seriously thinking about medicine in any form.

EMT class #1

  Who ever said EMT classes were easy are rediculous and must have had a stupid teacher. Everyone that has taken the class 5 years ago said it was simple, a cake walk, but many people are nearly failing in my class. Im studying my butt off every day, at least half the day.
   We are required to get 80% on ALL our tests, so there is alot of pressure to perform well on all tests.
Im working my butt off, doing everything I can to survive and learn stuff at near perfect level inside a compressed summer course....so much for a summer, 2 summers in a row....I can barely enjoy the short lived good weather we're having.

No sleep for medical students.

  I must say it is a very good intro level course that is really trial by fire into the vastness and depth of medicine....like riding a rocket strapped to your back.

  I'd recommend everyone to take it, that is seriously thinking about a future in medicine at any level. Many EMT's go on the become nurse, ER scribes, PA's and docs.

NanoBot Printing: big news...very useful

http://www.amusingplanet.com/search/label/Tech?max-results=10

Monday, April 2, 2012

0

Amazing Nanoscale 3D Printing

Posted by Kaushik at 12:03 AM

Researchers at the Vienna University of Technology have perfected 3D technology using two-photon lithography that can print orders of magnitude faster and smaller than similar devices. The 3D printing process uses a liquid resin, which is hardened at precisely the correct spots by a focused laser beam. The focal point of the laser beam is guided through the resin by movable mirrors and leaves behind a hardened line of solid polymer a few hundred nanometers wide.

This fine resolution enables the creation of intricately structured sculptures as tiny as a grain of sand. “Until now, this technique used to be quite slow”, says Professor Jürgen Stampfl from the Institute of Materials Science and Technology at the TU Vienna. “The printing speed used to be measured in millimeters per second — our device can do five meters in one second.”

In just 4 minutes it can print 100 layers consisting of 200 lines per layer. That translates into five meters of polymer printed in one second. In two-photon lithography, this is a actually a world record.

At the TU Vienna, scientists are now developing biocompatible resins for medical applications. They can be used to create scaffolds to which living cells can attach themselves facilitating the systematic creation of biological tissues. The 3d printer could also be used to create tailor made construction parts for biomedical technology or nanotechnology. But for now, the researchers are having fun creating models of racing cars, a model of St. Stephen’s Cathedral in Vienna, and the Tower Bridge in London.

Travel Doctoring

http://blog.gmedical.com/Locums-for-a-Small-World/bid/107235/How-Dr-Starkey-got-her-groove-back-An-open-letter-to-doctors-considering-a-locum

Locums for a Small World Blog

Current Articles |  RSS Feed

How Dr. Starkey got her groove back: An open letter to doctors considering a locum

Posted by Saralynn White

  

  

  

G'day all,

I’m asked a lot what it’s like to be a US-trained doctor working as an OB/GYN in Australia and New Zealand and it's a question I love to answer.

First, a bit about me. I’m from Buffalo, New York; I completed my OB/GYN residency at Magee Women’s Hospital at the University of Pittsburgh (Pennsylvania) in 1990 and went directly into practice that same year (I have been board certified since 1992). In 2005 I lost my mother and that year I realized I did not want to work so hard at the "business” of medicine. I had a Gynecology practice in the Finger Lakes area of New York, but no life. I went to work early, got home late, had dinner, watched a bit of TV, went to bed, and then did it all again. I told my patients to take care of themselves, but I wasn't taking care of myself. I had kept a postcard from Global Medical Staffing and that inspired me to take action. I told Molly (my partner) to start planning; I brushed up on my OB work and in 2007 we took a locum tenens assignment with Global. It was a step that reinvigorated me and I got my life back. Now, I just practice medicine—which I love. 

Since 2007, I have worked in the Caymans, on both islands in New Zealand, in two Australian States (Western Australia and Tasmania) and in Australia’s Northern Territory. I have loved each location and have traveled extensively before, during and after assignments. I personally prefer a six-month assignment, but many, many locums work for a year or more.

Working in the Southern Hemisphere has opened my eyes to medicine as it is practiced in other countries, including the UK, Singapore and India. Our American viewpoint is very welcome, but the UK Royal College Guidelines are first line as well in our field. It’s a breath of fresh air to see and learn other viewpoints (no, we Americans don’t know it all! There is definitely more than one way to "skin a cat"!).

The residents in New Zealand and Australia are a hard-working bunch. The hours are civilized, with morning report at 8:00 a.m., rounds at 8:30, clinics or surgery 9-12 and afternoon clinic or surgery from 1:00 until you go home at 4:00 p.m. Your call is 8:00 a.m. to 8:00 p.m. in Labor & Delivery, then the night person takes over and you go home. After a week of nights you generally have a week free.

Australia and New Zealand are obviously first-world countries, but I have had some third-world experiences. The Aborigine population, for instance, does not embrace preventive medicine. You’ll also likely treat some of the many immigrants from Asia and the Middle East. You’ll see and care for some interesting cases here, but your USA training will ensure you’re up to the task. In Australia, the junior staff are equal to USA residents from year 1-4, but they call themselves registrars and resident medical officers—all doctors in various levels of skill. Some may have been specialists in other countries but need to repeat their training to obtain full medical registration here. Or are general practitioners but want to work remotely and are up-skilling in the specialty.

Now about travel. I have ventured through much of Australia and New Zealand (and beyond)—yes, you’ll have lots of time to explore! The exotic country of Bali is a great weekend getaway. My favorite spots in Australia are Tasmaniaand the the "Bungle Bungles" in the Northwest portion of the continent. Darwin (in the Northern Territory) is on the water and just beautiful—like Florida or even Pebble Beach in California—but weejkend getaways in the outback desert are close. We were there in the rainy season still saw the sun a lor. For a portion of the year, we can’t swim in the ocean because of jellyfish and crocs (don’t worry, there are signs posted!) but we still enjoyed the huge 50-meter pools every day.

If you work in Australia, be sure to visit Uluru (that big red rock - Ayers - in the center of the country) and ride camels, swim with whale sharks, dive the Great Barrier Reef, taste all the different wine regions, fly into remote Tasmania by bush plane, climb the remote rocks in Kakadu Park and see rock drawings from 50,000 years ago, ride the Indian Pacific Railroad East to West or The Ghan train North to South, climb the Hanger Bridge and visit the Opera House in Sydney, descend into a gold mine, sail on an America's Cup boat in Queenstown, hike New Zealand's great walks, helicopter onto a glacier and walk on blue ice at Fox Glacier in New Zealand's Southern Alps, stand next to penguins all over the place....I think I’ve made my point!

A locum tenens assignment is the adventure of a lifetime; just keep your mind open, expect the unexpected, and learn ways to "be a good guest". I miss family and friends, but I keep in touch via Skype, email, Facebook and phone calling cards.

That's it for now, except this: Do it, do it, do it! One doctor in particular (who is just finishing her residency training) asked me about working as a locum and I told her the same thing. She has lots of time to eventually "get established and become one of the rat race."

Cheers,

Kathy Starkey & Molly Evans

Dr. Kathy Starkey, an OB/GYN, and her partner, Molly Evans, have chosen locum tenens as a permanent lifestyle. They're preparing to head out for their eighth assignment with Global Medical now, and their previous adventures have taken them to New Zealand's North and South Islands, the Cayman Islands, Western Australia, the Australian island state of Tasmania, and the Top End of Australia in the Northern Territory.

Tags: Tasmania, Saralynn White, Dr. Kathryn Starkey, Uluru, Northern Territory

Game Changer in ER medicine: Oxygen Micropheres for fast response to lung collapse

NEWS  //  BIOMEDICINE

Microspheres Could Save Patients Whose Lungs Have Stopped Working

Doctors could eventually use the method to quickly reverse oxygen deprivation.

5 comments

SUSAN YOUNG

Wednesday, June 27, 2012

Air bubble: An intravenous infusion of oxygen-filled microparticles (the yellow sphere in this composite image) could carry the life-sustaining gas to red blood cells in patients with sudden loss of lung function.
D. Kunkel/Dennis Kunkel Microscopy, Inc.; D. Bell/Harvard University; J. Kheir/Children’s Hospital Boston; C. Porter/Chris Porter Illustration

Researchers have developed a way to deliver oxygen to the body's organs safely—via gas-filled microparticles—even when the patient's lungs have stopped working. Doctors could one day use the method to quickly reverse oxygen deprivation in patients with acute loss of lung function while longer-term fixes such as heart-lung bypass support are put in place.

Even short periods of oxygen deprivation put the vital organs of the body at risk. Typically, doctors feed oxygen-deprived patients the gas through ventilators such as tubes in the mouth or nose, but the treatment depends on functioning lungs. In situations where the airway is blocked or the lungs do not work, few options exist.

In such cases, injecting pure oxygen into the body is not an option because it can form bubbles in blood vessels and block blood flow. Some hospitals have machines that can oxygenate a patient's blood outside of the body, but the surgical procedure to hook up such a bypass machine is complicated and can take too long in an emergency, says study author John Kheir.

As a first-year fellow at Boston Children's Hospital a few years ago, Kheir treated a nine-month-old girl whose lungs had been damaged by pneumonia and were filled with blood. In the 20 or so minutes it took for Kheir and his colleagues to put her on the heart-lung bypass machine, she suffered severe brain injury from low oxygen levels and died. The experience led Kheir to work toward developing a fast-acting, intravenous treatment that could help patients like her with acute, severe lung injury. "The only way to save someone like that would be to inject oxygen directly into the vein," he says. 

Blood substitutes that carry oxygen are available for transfusion, but are known to cause dangerous side effects and furthermore typically rely on functioning lungs. "There really is a need for something that you can pull off the shelf, and give to people to pull them through these critical periods," says Ann Weinacker, a lung and critical care doctor at the Stanford Chest Clinic.

Kheir's oxygen-filled microspheres, reported today in Science Translational Medicine, are around three micrometers in diameter and are diluted in a solution commonly used in transfusions so that the particles can flow through even small capillaries in the body. In test tubes, the researchers found the oxygen transferred from the microspheres to hemoglobin, the protein in red blood cells that carries oxygen, within four seconds. They then tested the microspheres in anesthetized rabbits with blocked windpipes. Although the rabbits were asphyxiated, their bodies were oxygenated and did not show signs of major injury to organs.

More research is necessary to determine how long the therapy can work and for how many patients it could be useful. "Situations where you have a short-term need [for oxygen] and everything else is working are not that common," says Gail Weinmann, a lung disease expert with the National Heart Lung and Blood Institute. But when those situations arise, a quick infusion of oxygen could be life-saving, she says. "As a bridge, even 15 minutes could make a difference in some situations."

Kheir says the intravenous oxygen delivery could help not only in the critical moments when heart-lung bypass machines are being set up, but also when patients are being put in intensive care on ventilators. Unstable patients with low lung function are also at risk of severely low oxygen levels, he says. "[The goal] is not to make ventilators obsolete, but to make patients healthier," says Kheir.

Kheir says that more lab animal work is needed to explore the clinical utility of the microsphere technology, which he and some of the study coauthors are patenting. "We are testing the ability of these particles to deliver oxygen in other clinical circumstances, such as cardiac arrest and severe bleeding," he says.

The team is also working on making the microspheres more stable, with the ultimate goal of creating an off-the-shelf solution that could be ready for quick use in emergency situations.

Plantar Fasciitis

ESWT Sound Wave therapy:
http://www.heel-that-pain.com/other_treatments/eswt.php

Alzhiemers Triggers Found

An Alzheimer's Warning 25 Years Before Symptoms Show

The rise and fall of certain proteins can indicate dementia's onset decades before the appearance of symptoms.

7 comments

KAREN WEINTRAUB

Wednesday, July 11, 2012

Early onset: Brain scans show evidence of Alzheimer’s disease 20 years before symptoms arise (far left), 10 years before (middle), and after the onset of symptoms (right). Beta amyloid, a protein associated with the disease, is more visible in people who develop the disease (top row) than in those who don’t. The more color in the scan, the more beta amyloid is present in the brain.

The first detectable signs of Alzheimer's disease occur as long as a quarter century before symptoms like memory loss become noticeable, according to a detailed chronology of molecular changes to the brain and spinal fluid of people who later developed the brain disease.

The research, published today in the New England Journal of Medicine, provides a timeline of the subtle changes that begin in victims' brains and, importantly, can be detected years ahead of time by MRI exams, blood analyses, or other tests.

The development of biomarkers that can track and predict the natural course of the disease is important for carrying out drug studies, in part because changes to these molecules could give early hints that a drug works. Treatments for Alzheimer's have all been unsuccessful so far—in part, researchers think, because people received drugs only after symptoms had become obvious and their brains were too damaged to recover.

"This is perhaps the most comprehensive picture of what changes, in what order, and by how much," says Randall Bateman, a professor of neurology at Washington University School of Medicine, and the study's first author.

Now, with a roadmap of the disease's signature, Bateman says, doctors will have a better chance of judging whether a treatment is working by looking at interim measures rather than waiting until the disease is full-blown. Bateman is participating in a set of important new studies to see if Alzheimer's can be prevented. The two-year drug trials involve currently healthy patients who carry genes for an early-onset, inherited form of Alzheimer's. The biomarkers will be used to judge whether the medications are helpful at preventing or slowing the course of the disease.

A combination of factors similar to those that lead to heart disease—diabetes, poor diet, lack of exercise—are associated with the development of Alzheimer's, although the disease's root cause is still a matter of scientific debate.

The timeline was constructed from studies of 128 people from families plagued by a rare, inherited form of Alzheimer's in which symptoms emerge in patients still in their 30s, instead of after 65, as is the case with most of the five million Americans with the disease.

According to the study, levels in the spinal fluid of Aβ42, a protein associated with Alzheimer's, begins to decline 25 years before the onset of symptoms; at 15 years before symptoms develop, levels of another protein, called tau, begin to rise, and some brain shrinkage and atrophy is evident; at 10 years out, the brain's consumption of the sugar glucose is discernibly lower, and some memory impairment can be measured.

The researchers created the chronology by measuring the key molecules in volunteers who are healthy, but whose genes predict they will develop Alzheimer's. By learning at what age those volunteers' parents first developed Alzheimer's symptoms, the researchers were able to infer the time span between the molecular changes and the disease's onset.

Family members who did not inherit the Alzheimer's genes showed none of these early signs of the disease, Bateman says, suggesting that the markers really do distinguish between people with early-stage disease and those without. It remains to be seen whether the biomarkers can also predict Alzheimer's disease in the general population.

The Washington University scientists continue to look for more families with the genetic form of Alzheimer's to join its study, which is recruiting families with a history of early-onset Alzheimer's spanning three generations.