Hello Amorous Congress-Stick

Depression in Med School: You’re Not Alone

Kelly Chi, MS
Posted: 03/29/2011

Recent studies have highlighted a problem that many medical students know about all too well: the prevalence of depression and burnout in medical training. On student discussion boards, the stories put a human face on this troubling issue.

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…put the 80/20 rule to rest…

This past Sunday, I went to brunch with the E.D. nurses and some M.D. mos…and out of nowhere I hit off conversation with the one resident about my educational tract.  Step two is something on the near horizon for me…in fact, it’s more staring me down than I am looking towards it.  This stupid board test is just another means to get closer to a goal I am not even sure I am still reaching for (not to mention it’s 500$ I could be spending on something else in my life that I AM sure about).

The test itself is nothing of concern over material.  It focuses on random crap like infectious disease, immunological disorders, mental disorders, cardiovascular, field injuries, GI, Gyno, pregnacy, endocrine disorders…all stuff I’ve held a job specifically dealing with, or took classes in undergrad focused in them.  Of course there was the two night lecture series I instructed this past fall here at NYU about blood cancers and such things related.  The only two areas I’d have to review and spend time with would be most things specific to the nervous system and complications stemming from renal issues.  

The more I continue with my education…the more I grow disinterested in my professional dreams of the past and more inspired to do something else…and wildly differing from what I originally thought.  I avoided the topic of becoming an educator while in undergrad…because honestly, trying to explain or teach someone what they don’t know pisses me off when they don’t retain it as soon as I go over it.  Buuuuuuuuuuut recently, the more I’ve returned to the lab…the more I think I am in favor of being a collegiate professor of medical sciences and work in biomedical research.

Because of my wavering degree sot issues, I went part time this last semester in order to figure out- MD/MPH/PhD/DNP/DO (lol…def not DO at this point)/etc.  I’ve applied to the appropriate programs and will know for sure what options I have in about 5 more weeks….but to bide some of my time, I went and attached myself to a research project within the department I did a rotation with in Jan.  I have not done something to have my name published since 2007…and well…I’m overdue.

So I picked up research on HCV drugs.  I’ve spend numerous hours cultivating liver cells for the hep c virus to grow in, and getting pissed off about the two month life cycle/how to extend it in order for the virus to exceed a certain population to test various applications for treatment leading to a vaccine to lead into trials.  Recently there were unforeseen variable…which inevitably just pissed me off to return a new ‘batch’ to step 1 all over again…but equally, if not more, starting over rejuvenated my approach to how things are and could be changed to further and extend it.  What seems little, is actually a big thing…extending these infected cells life span by hours saves time and more accurately directs the means of which the drug testing goes.  It’s efficiency…and that turns me on.  lol.  

Of course I just avoid talking about my personal involvement or accomplishments with it, because them people want to talk about it, and then I feel like a nerd or feel like I alienate people when I talk about it or get annoyed when I feel like I am explaining I think everyone knows.  Just it just goes unsaid, or just in little ‘briefs’ with friends.  It’s not think my friends couldn’t handle understanding and learning about what I do in the lab…but when they are all friendly about it and check in, I feel more pressure…and I just need to do my thang.  Plus, friend time is not school time, and I appreciate keeping the worlds as separate as possible.  So from what little I’ve talked about this in the last few months, or what I sarcastically joke about, a few people (I think) think I’m growing shrooms (or just regular fungus) in the labs.  

I oddly love OB/GYN/IVF related…and something I think I want to seek out is how to create a way to biologically develop and embryo coming from two same sexed parents.  This would require ova cells and the ability to host without a haploid status long enough to transfer material…but these are so fragile…blah blah blah.  It can be done, and I’m sure someone somewhere is working on it.  I want to spend more time on how this genetic engineering exists in research currently…but I think it’s perhaps where I’m going.  Being about to the share (teach this) would be amazing!

On the topic of ‘teaching’; throughout my day I get texts from non medical (and sometimes medical) friends asking me random things…and the idea of guiding them in the direction towards a cleared answer in their health…or with their relationship with someone who can better serve them is what I enjoy.  So I text medical advice throughout the day…and for the one who follows me on here with his virtual health clinic, I’m sure you’ll agree to this being a better and more effective relationship to have with patient communities.  You put the 80/20 rule to rest more when you are not face to face and it builds up a patients confidence to better seek out what they need to do for their health.

So with all of this…and my random conversation with my new E.D. resident acquittance…I think I’m more comfortable and less stressed about where my education is going.  I’m still not sure about Step 2…but also, I’m not fully a ‘year 3’ to HAVE to worry about it just yet.  Plus I was encouraged to put it off towards the end of the testing period anyway.  Let’s see what these department programs send back to me!

Stem cells from umbilical cord blood eyed as new weapon against AIDS

By Stephanie Pappasupdated 3/6/2011

Last year, doctors in Berlin made an unprecedented announcement: They declared an HIV patient who had undergone an HIV-resistant bone marrow transplant to be cured of his disease. Now, doctors in Texas are hoping to build on that success story by screening stored umbilical cord blood for HIV-resistant stem cells that could be transplanted into patients.

The treatment would benefit only a small group of people who have both HIV and certain cancers, and the chance of finding a suitable genetic match between stem cellsand patients is low. It’s also risky – almost one-third of patients who undergo the bone marrow transplant procedure die. But the research is part of a wider push to develop drug-free ways of living with HIV.

Drug therapies have been a godsend for patients who would have otherwise died without them, said Paula Cannon, a stem cell researcher at the University of Southern California’s Keck School of Medicine. (Cannon was not involved in the Texas study, set to be published in an upcoming issue of the journal HIV Medicine.)  But as HIV patientslive longer and longer on drugs, side effects, such as diarrhea and nausea, and cost become major problems.

Story: Cure for HIV claimed, but not proven

“It’s good for us to be bold,” Cannon told LiveScience. “We’ve applied the tourniquet, we’ve stopped the bleeding. But now, can we do something to fix the underlying wound?”

Transplanting resistance 
The study focuses on cord blood, which comes from the placenta and umbilical cord of newborns and contains stem cells capable of becoming any type of blood or immune cell.

The researchers knew that a small number of people — perhaps 1 percent of Caucasians and fewer people in other ethnic groups — have a natural resistance to HIVbecause of a genetic mutation. The mutation, called a delta-32 mutation, affects an immune cell protein called CCR5. This protein is the port of entry for HIV into the body’s immune cells. People who are homozygous for the mutation — meaning they have two genetic copies of it — are resistant to HIV infection.

“We had this idea that in all these cord bloods that are being donated to our banks, there’s probably a certain percentage of them … that are heterozygous and homozygous [for the mutation],” study author Richard Behringer, a geneticist at MD Anderson Cancer Center in Houston, told LiveScience. “And if we could identify those homozygous samples, those could be banked as a potential stem cell therapy for HIV infection.”

The idea echoes the case of the Berlin patient, whom doctors pronounced cured of HIV in the December 2010 issue of the journal Blood. That patient had both HIV and leukemia. He received two bone marrow transplants in 2007 for his leukemia, but doctors made a point of seeking out donors with two delta-32 mutations. They killed the patient’s own bone marrow and transplanted the donor marrow in its place. The stem cells in the donor’s marrow took hold and repopulated the patient’s immune system. As a side effect, the man’s body became inhospitable to HIV (though researchers warn a small amount of the virus could still be present in his body).

The potential cord blood treatment would work in much the same way, except that instead of an adult donor, the stem cells would come from a frozen vial of cord blood. After screening more than 1,500 cord blood samples donated at three hospitals in Houston, Behringer and his team turned up 10 HIV-resistant samples. Two failed the quality control standards necessary for transplant, leaving 8 potential samples awaiting the right patient.

Risks and drawbacks 
Behringer is quick to note the drawbacks of the cord blood treatment. Any transplant carries the risk of rejection, and bone marrow transplants can sometimes take root and attack the rest of the body. Genetic matches are hard to make. Knocking out the patients’ original immune system leaves them vulnerable to infections that the body can usually fight. According to Kristina Allers, a doctor at the Charite University Medicine in Berlin who worked with the Berlin patient, 30 percent of bone marrow transplant patients die.

Because of the risk, the potential HIV treatmentis very unlikely to be used on patients with HIV alone. Attempting to cure HIV with this method can only happen as a side effect of treating an immediately life-threatening cancer. That doesn’t mean that screening cord blood for HIV resistance is a waste of time, said Cannon. She called the treatment “important, if it’s you.”

“At this stage, it’s good that people are starting to collect this information,” Cannon told LiveScience. But, she said, “I don’t see it as something that is going to be widely applicable.”

Cell transformation 
For treatments with wider implications, researchers are working to turn patients’ own cells into delta-32 mutants. The research is still in the early stages, but researchers are cautiously optimistic about some early results.

In one line of work, researchers including Cannon are taking stem cells from the blood and treating them with enzymes called zinc finger nucleases. These enzymes act like “molecular scissors,” Cannon said, snipping the CCR5 gene to mimic a delta-32 mutation. The idea, not yet tested on human patients, is that the modified cells can be injected back into the body, where they’d start reproducing. HIV cellscould still invade and kill unmodified immune cells, but the hope is that the modified cells would survive and thrive, Cannon said, ultimately preventing full-blown AIDS.

An early test of a similar concept, this one using specially engineered viruses to modify patients’ stem cells, showed some success in humans, researchers reported in June 2010 in the journal Science Translational Medicine. That experiment transplanted modified stem cells into four patients with lymphoma and HIV. The cells were modified not just on the CCR5 gene, but also with several additional changes to prevent HIV from mutating and using other ports of entry into immune cells.

For ethical reasons, the patients received mostly unmodified stem cells, making it impossible to determine if the modified cells could have treated the HIV. But the modified cells appeared to be safe, and they were present up to two years after the transplant, study co-author John Rossi of City of Hope Hospital in Duarte, Calif., told LiveScience. Clinical work continues, Rossi said.

“We’re trying to optimize the number of genetically modified cells that the patient receives,” he said.

Another study, presented at last week’s Conference on Retroviruses and Opportunistic Infections in Boston, dispensed with the stem cells altogether and modified the immune cells directly using the same enzyme technique used in Cannon’s research, an approach with fewer safety issues than stem cell therapies, study author Jay Lalezari of Quest Medical Research in San Francisco told LiveScience. However, Cannon said, immune cells don’t live forever the way stem cells do, so that treatment would likely require gene therapy booster shots.

All of these treatments are a long way from providing the longed-for cure for HIV, researchers say. But the Berlin patient’s success has given the field a boost.

“We’re all congregating around the fact that having CCR5-negative cells in a patient’s body is probably going to be a good thing,” Cannon said. “There’s just different ways to get there.”

***Any progression to eradicating active HIV status in people, I am supportive of.  Where I tend to ‘fence’ thoughts- application or treatment path.  Granted, my risk/benefit views pan out due to being less biased than someone with something personally at stake with sot application of this new treatment.  Not to mention, the one man they reference (if I can remember correctly from when this made news 9 months ago) was off his HIV medication to to conflict with Leukemia treatments…and the HIV negative status was a fluke in the end, not part of the initial treatment goals.  This was a turning point in how to guide research and treatment down a new path, and have an example for monetary donors to see off a hypothesized paper study.  The numbers are stunning through…with the treatment application, there is a roughly 36% odd of dying while in procedure…but source of the treatment seems to currently hover a .5% presented samples from annual available sources.  Based on this information and existing generalized odds:

~1 in 3,000 HIV+ patients could be treated.
~1 in 3 of treated patients would die during procedure.
~For every 3 patients who survive the procedure, at least 1 will reject the new bone marrow.

Obviously this comes with a ‘who should be treated first’ protocol which needs to be developed (eluding to those who are both HIV+ and have aggressive cancers which can be treated).  This is obviously not a ‘be all, end all’…but I think it’s opened a floodgate of new research and perhaps a closers, more obtainable means to help this disease in conjunction with a treatment procedure which is growing more routine and increasing beneficial odds of survival.  ***

Scientists coax a bit of stretch into artificial blood vessels

February 21, 2011

The artificial vessels created by Humacyte do not perfectly mimic nature’s recipe. They lack a major component of natural vessels: the protein elastin.

Scientists at the University of Pittsburgh have now coaxed engineered vessels to make elastin, they reported Feb. 3 in the online edition of the journal Proceedings of the National Academy of Sciences.

The rubber-band material that allows veins and arteries to snap back into shape after every pulse, elastin has long been one of the greatest challenges in any attempt to make artificial blood vessels. Without it, a vessel might eventually become stretched out like an old rubber band — and a stretched-out blood vessel can mean a dangerous aneurysm.

“Elastin has been very elusive” among blood vessel engineers, says Yadong Wang, an associate professor of bioengineering, who led the study. Scientists can boost the protein’s levels by adding artificial genes or growth factors, he explains, but such complicated treatments could be risky in people. Wang and colleagues created grafts that had 20% of the elastin found in normal vessels, the highest amount yet reported. Plus, Wang says, the body’s cells will add more elastin once the graft is implanted.

Wang’s group persuaded cells to manufacture elastin simply by growing baboon smooth-muscle cells in a stretchy, elastic, biodegradable scaffold. The process only took three weeks; the scientists are now testing their grafts in rats.

Although Wang’s vessels have just one-fifth of the natural amount of elastin, that’s more than other researchers can boast. Robert Tranquillo, a biomedical engineer at the University of Minnesota, Twin Cities, estimates that he gets 1% to 10% in his own artificial grafts.

Wang’s artificial vessels can withstand about 200 millimeters of mercury of pressure; healthy blood pressure maxes out at 120. Wang calls it “a reasonable safety margin,” but Tranquillo says it is insufficient for clinical use.

***I have to give a shout out to my alma mater for this research.  Just real quick on this topic…I’m excited for the progress and the potential to aide in future bypass graft/dialysis shunt procedures which would leave vein harvesting unwarranted.  Woot!***