Se La Vie…

Well, it has been what feels like aeons since I last posted. I’ve been through a metamorphosis of sorts. I realized that when you throw a bone in an offerance of friendship and the person you are throwing it to turns up a nose that it is time to let it go…so, I am letting go of the idea that “hotness” and I will EVER be friends. It was hard for me to do. I get attached easily. I love people freely; and, I put people on pedestals..perhaps that is the problem…even though I think people are perfect no matter what they do, when one has a knowledge of my deep admiration…well, I guess it can be disconcerting.

The “getting over” something that I thought would lead to an amazing friendship was hard to do. I pretty much had a down-ward spiral and stayed in bed for four days (not something I am inclined to do, as normally I am a pretty  happy, bubbly person)…but I was saddened. I felt loss…loss hope, loss of discovery…loss of motivation…loss of enrichment…loss of trust (of myself, mostly)…and loss of a vision whereby I’d have a friend who is an exceptional Health Care Professional give me a little guidance. I know that sounds like I was out to manipulate the friendship I desired in an unethical way, but I wouldn’t have…just to talk about perspectives, to have someone who is brilliant give feedback would have been phenomenal. And, I would have given back anything needed THAT WAS LEGAL AND  MORAL with all of my heart, mind, soul — every fiber of my being.

Another component of  my metamorphosis was realizing that if I am not obtaining means and mechanisms to grow my skills at the facility in which I work that I need to go to a facility, at least a few days a month, that will enable me and empower me to do so….therefore, I am job hunting for a second job. Ideally, I would like to be in an acute setting whereby I see more critical cardiac cases that translates to the reading of harder telemetry strips. This would enhance all the study that I am doing. I plan to take the National Certification test at the end of April. If that opportunity is not available, then I’d like to work in a Dialysis environment since I am a Certified Dialysis Technician.

Another “change” that is positive in general is that I have a definitive start date for RT school. I will start April 13th. I am going over all of the Anatomy, Physiology, Chemistry, Biology, and Pathophysiogy I can to be as prepared as possible. I am reading a book entitled “CardioPulmonary System Review,” which starts at homeostatis and advances to more complex information and formularies.

So, I’ve  had personal progression and digression simultaneously over the past few weeks..and I am somehow becoming a little wiser…to the point whereby I can sometimes non-chalantly say: “that’s life.”

A-flutter…

This strip was the one that I previously mentioned that taught  me the importance of being observant, even in the midst of report. Our standard format is to read the tele strips with the top lead as II and the bottom lead as either V or MCL. Our hospital policy is that we are never to turn off alarms…so even when a patient is in A-fib, for instance, the alarms that ring “irregular heart rate” are perpetual and constant. So, the previous tele, to get around incessant alarming (because the patient was stable and asymptomatic) changed the lead reading to prevent alarming. The lead reading was put as a V lead for the top strip and II for the bottom strip. I was not informed of the change and didn’t notice it as I hadn’t settled in to my station and was in the midst of getting report. So, I saw what  was alarming: “V-tach.” When I ran the strip and looked at it and had the Doc and the Nurse review was my face red…the II lead made the rhythm an obvious A-flutter…(there is some wandering baseline and artifact, but the rhythm was definitely NOT V-Tach).

Hot and Bothered…

Well, I haven’t worked a 20+ hour shift on only 4 hours of sleep for about 8 years and found that I really LOVE it!!! I must be somewhat of an adrenaline junkie, after all! But a lot happened to pique my interest and challenge me. I worked with deaf Nurse who can’t hear alarms or ANYTHING. I love her to pieces, but we really need to work on our communication! She can’t hear me with my high pitched voice; and I often can’t hear her as I am listening for Tele alarms with diligence. She asked me to input orders and I couldn’t hear every parameter, so I had to ask her the same question umpteen times (yes, I am probably a little deaf, too).

Furthermore, HOTNESS was there. I didn’t expect that my 20 hour shift would include him because I thought he was off for the Holiday’s…but he was there…it is a smiley moment and an adrenaline rush in and of itself to see his face lit up when he smiles or  laughs. I melt a little inside whenever he and I engage in polite conversation…(a rareity because even though I would probably stop crushing on him  if we were friends, I just can’t win him over enough to be anything more than “ancillary staff,” so the awe I have for his beatific countenance has to suffice). The BIG adrenaline rush came when he and I had a brief discussion about how divorce makes too many adults egocentric and the kids, who should come first don’t. THEN it got better!!! He needed someone to brace a patient who had been admitted for a drug overdose…the patient was having seizures and tremors and an ART line needed to be placed.

Hotness can usually get his ART lines in lickety split…this one was a bit more challenging because the patient would twitch immediately after the line was threaded and a flash occurred. So after four attempts at this I devised a better way for my 4″11″ frame and child sized hands to hold the arm of the trembling patient…I sat cross legged on the floor under the arm of the patient. I was able to get a good angle, hold the arm down and the muscles taut…and we had success!

Part of the adrenaline rush I felt came from the fact that I have never seen an ART line placement up close and personal. I got to see how the RT places sutures in the line; the appropriate technique to palpate for the artery then the method used to thread and tie the suture. In addition to the rush from the learning process. I got to be near my idol and admire his work, handsome face, lovely abductor longus pollicus, and chat with him about anything, nothing, and everything. Although I had butterflies in my stomach the whole time (worried I would say or do something wrong) I realized the pricelessness of the moment…I will never have an opportunity to engage idol in this carefree (yet serious) manner again.

Some of the other interesting happenings from this eventful shift…I got to work with one of my favorite Doctor’s — he is thorough and brilliant, he admitted three other patients to our ICU…I was able to complete all of the orders, run labs and their results, and help with patient care. I think this Doc appreciates my work (I am diligent and have a strong work ethic) so he kept asking me to reprint results and do a few things for him as I was running from patient to patient to ensure all cares were completed.

The only moment we had differing opinions about was a peaked T wave. I felt the elevated measurement was high enough to indicate it as a peaked T wave (a sign of electrolyte imbalance) and he felt it was normal…so I was humbled and taught another valuable EKG lesson….

It was a hot night in terms of  all I learned, witnessed, and attempted to do…such an amazing night of learning and figuring out better ways of doing things; with an amazing EKG strip to boot…and although I completed all of my required work, I didn’t get the extra “AnnieC” touches finished..and that is why I am a little bothered…

SVT…Whaaaaat?

The  patient was a 50 year old male admitted for  bilateral pneumonia. He was originally just placed on O2 mons. His oxygen dropped to 83%…and then whammy…his heart rate more than tripled!!! He went from 67 beats per minute to 203. A manual count of the patients heart rate confirmed that he was experiencing an elevated rate that was over 200 beats! The Doctor ordered that the patient be placed on portable Tele monitors in addition to his pulse oximetry monitoring. Furthermore, a 12 lead EKG was ordered. Both my monitors and the EKG confirmed that the paitent was in true Supraventricular Tachycardia. The Doctor ordered adinosine….heart rate dropped to 200, then a HUGE pause with small T waves present…then the patient converted to Sinus Tachycardia with a heart rate of 113 per minute. Slowly….the patient moved from Sinus Tach into Normal Sinus Rhythm with a heart rate of 87.  One surprising component of this monitor (for me) was that the patient didn’t pause, manifest a 3rd degree block THEN convert to NSR…instead it was pause, Sinus Tach, then Sinus Rhythm. More surprising…after 40 minutes sans adinosine, the patient bradied down to a heart rate of 53 beats per minute. I’ve never seen a cardioversion with adinosine take on the precise characteristics that I experienced…I was slammed with other critical patients, so did not have an opportunity to discuss the situation with the Doctor or Nurse’s….but I wonder why the patient bradied so low in such a relatively fast time-frame?– especially since he was given only 6 mg of the drug……When I have more answers, I will share my findings…but overall,what an interesting strip to witness…

Death….

A 94 year old patient of mine was struggling to breathe. He had aspirated earlier in the day. He was full code. Prior to intubation, both the Doctor and the Respiratory Therapist described the procedure to him and asked if he wanted to be placed on a ventilator to help him breathe with more ease. He finally came to the decison to declare himself DNR/DNI  and decided against intubation.  At about 3am, he was had wheezing and was gasping for air. His O2 sats remained 95% but he was definitely in distress. He was placed on bi-pap with a full face mask. This comfort measure didn’t help and made the patient more agitated. So, the bi-pap was discontinued. Shortly thereafter, the patient’s skin became clammy and was starting to mottle. The Nurse’s were trying to predict time of death. The patient was not experienceing Cheynne-stokes breathing; nor were agonal breaths apparent…..just the wheezy, watery sounding breath that is often associated with aspiration pneumonia. I really didn’t think the patient would die. Although there were significant signs that he would pass, I thought it would be later in the morning after shift change; and, I didn’t agree with any of the Nurse’s time parameters. In my 15 years as a C.N.A. I have seen hundreds of patients with the same symptoms live from days longer to weeks longer…so I was surprised that this patient died — especially since the family present expected more family from out of State to arrive later in the moring to say their good-byes to him. I guess the signifant lesson for me is that a prediciton of death is a 50-50 statistic…ultimately, a patient will die when he or she is ready. I am grateful that we didn’t prolong his life and cause any further stress or pain in an attempt to do so. He was able to pass peacefully with his wife and a few of those he loved holding his hand.

I’VE RUINED MY LIFE….

“Yet I am not more sure that my soul lives, than I am that perverseness is one of the primitive impulses of the human heart–one of the indivisible primary faculties, or sentiments, which give direction to the character of Man. Who has not, a hundred times, found himself committing a vile or a stupid action, for no other reason than because he knows he should NOT? Have we not a perpetual inclination, in the teeth of our best judgement, to violate that which is LAW, merely because we understand it to be such?” -Edgar Allan Poe

Although, I know right from wrong, and often choose what is morally right, I don’t always  have a gauge to stop me from choosing what is wrong. When I choose wrong, it is always to my detriment and ruin and despair…so why do I still get myself in the kind of situations where I choose wrong? In my need to connect with people, and make friends at school, I loaned a class-mate a paper I wrote last semseter (buts like 3 content from three semesters ag). I naively thought she would look at it to get ideas, perhaps see how I incorporated APA into my paper, and perhaps use a few quotes (citing them appropriately)…well, she turned in MY paper as her own original work. In my institution, all papers get electronically scanned for review…this paper was reviewed and we both got summoned to the Dean’s office. The Honor Code in our school considers my lending and her using my paper the equivalent of cheating…and we are both under review with the likely outcome of  expulsion. Worst case scenario for me because I go to two Universities is that I will be expelled with no return provisions from both institutions; additionally,  I could possibly have the three degrees I currently hold remanded…so, all the years of work, all the money…well I am ruined. This 18 year old will progress and go on…she will probably get a Real Estate license and have a life and a career…for me I am out of money; and I, feel out of time…the rest of the days of my life will be working as a lackey,  and living in survival mode…always working two jobs, perpetual tiredness, no challenge…..every worst nightmare I’ve ever envisioned for myself. But even harder is the self loathing I have for my self for not having good moral fortitude. The worst part is it is all of my own doing. How did I get to the point where I made a choice to so blatantly  sabatoge myself? I think the worst thing for me is that I have become the person I despise most…one who cheats the system to get ahead in life (my mother).  I am numb and I am lost….

Thanksgiving version 2008…

I think service is very important, but I rarely have the time to give back to my community with the capacity that I desire. So, as a service commitment,  I generally volunteer to work the Holiday’s so that those with children can have time with their family and not have to worry about time parameters or making it to work despite a busy and full day. My service commitment makes my husband commit to that same service endeavor, too..therefore,  we don’t celebrate Holiday’s on their designated day, but a day prior to or after the event. Normally, on the day we designate as our celebratory day, I go all out and cook a very nice, albeit,  traditional meal with a few new recipes added in to make things special. I usually set a nice table for just the two of us and light candles. This year, I am still planning to do that, but it will be 3 weeks after the Holiday due to work and school issues.

The problem I faced was the fact that we still needed to eat today; so, I made chicken fajitas and nachos with a spanish corn and salad on the side. Nothing really fancy. Nothing time consuming. Nothing that would makes us feel gluttonous…and it WAS good. But something was missing….and then I realized it was our tradition of telling each other what we were grateful for. Husband wasn’t in the mood to play…so, here are some of the things I cherish:

1) Having a Husband who allows me to promote a “service” ideology, although it often places him last.

2) Having someone in my life that loves me despite my flaws, selfish moments, and moodiness.

3) Having someone who adores me so much that I am considered beautiful, even though I am only 4′11″ and am not a size 00.

4) Being able to share the experience of life with someone…someone whom I can make laugh and who makes me laugh.

5) Having a wide open heart that offers love to whomever I meet…I really DO look up to everyone.

6) Having the resources to own my home…money-pit that it is.

7) Having a reliable car that allows me to commute 2 hours a day to school.

Being able to find a way to pay for school; and continue my educational endeavors.

9) Having a Spouse who isn’t critical of me, even though I can’t seem to make the first round of educational endeavors work.

10) Having a job that is exciting, interesting, that propels me to be a better human being, that teaches me continually, that allows me to work with brilliant and interetsing people.

11) Having a voice to express my thoughts, feelings, ideas, angst…I am so grateful that I have these and other freedoms.

12) Knowing that I have friends that truly care whether or not I get up in the morning.

13) Having a reason to get up each day.

14) Having the honor of knowing military personnel that fight for the American way; and try to teach its beauty to those in other lands.

15) Having the will to pick myself up, wipe the dust off, and try to progress forward…even after I made a doozy of a mistake.

16) Grateful that I get to ski once a year.

17) Appreciative that I have step-daughters who are amazing; and step grand-children who are treasures.

18) Knowing that even though I may never be a mother in the true sense of the word; I gave life to an incredible woman who means the world to so many people. If I never accomplish anything else in my life of worth. I have done ONE good thing.

There are so many more things I should list because I know I have been given much. What I have learned thus far is that life is not always easy. I believe that trials and tribulations are there so that we may learn the lessons specific to us as individuals…the ones that we need to embrace and learn to help us progress and gain the most wisdom. That is why the journey, for each of us is so vastly different.

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;

Then took the other, as jus as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that, the passing there

Had worn them really about the same,

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.

I shall be telling this with a sigh

Somewhere  ages and ages hence:

Two roads diverged in a wood, and I –

I took the one less traveled by,

And that has made all the difference.

The Road Less Taken, by poet Robert Frost

The Heart…Truly the Center of the Universe…

Chest pain after emotional and physical upset

P Parulekar, senior house officer, M Z O Khawaja, specialist registrar, E T McWilliams, consultant

¹ Department of Cardiology, Conquest Hospital, St Leonards-on-Sea TN37 7RD

drzeeshan@doctors.org.uk

 

Case history

A 61 year old white woman attended her local accident and emergency department with severe central chest pain. After being chased by two large terrier dogs. The pain was not relieved by nitroglycerine spray given in the ambulance. An electrocardiogram showed anterolateral ST segment depression, with an elevated troponin T of 1.25 µg/l. She had no cardiovascular risk factors. Non-ST elevation myocardial infarction was diagnosed, and the patient was treated accordingly.

Coronary angiography showed normal coronary arteries, but the left ventriculogram showed a large area of apical hypokinesis with moderate impairment of left ventricular systolic function.

The patient was readmitted several weeks later with further chest pain. An electrocardiogram showed no new changes with no rise in the cardiac troponin. An echocardiogram showed that her left ventricular systolic function had almost returned to normal.

 

Questions

 

1. What is the diagnosis?

2. Which patients are most at risk?

3. How should these patients be treated?

4. What are the characteristic findings?

 

 

Show Answers

Answers

Short answers

1. The diagnosis is tako-tsubo cardiomyopathy, also known as left ventricular apical ballooning and “broken heart syndrome.”

2. It has been traditionally associated with emotional or physical upset in postmenopausal women.

3. Patients should be treated as for acute myocardial infarction. Many develop symptoms of acute left ventricular failure and should be treated as per current guidelines (nitrates, diuretics, etc).

4. Characteristic findings are:

Chest pain or dyspnoea

Electrocardiographic changes suggestive of acute myocardial infarction or elevated cardiac troponin

Triggered by emotional or physical stress

Normal coronary angiogram

Characteristic left ventricular apical “ballooning”

Tako-tsubo cardiomyopathy
Tako-tsubo cardiomyopathy is an increasingly recognised cause of chest pain and dyspnoea in postmenopausal women that often mimics acute myocardial infarction, and should be considered in its differential diagnosis. It was first described in Japan¹ but has subsequently been identified in the USA and Europe.^{2 3 4 5} The condition is sometimes triggered by an episode of emotional stress—hence the occasionally used name “broken heart syndrome.” A recent meta-analysis found an emotional stressor in 27% and a physiological stressor (asthma attack, medical examination or procedure) in 38% of patients.⁶ Initially underestimated, the literature reveals consistent prevalence rates of 1.7-2.7% in patients presenting with presumed acute myocardial infarction.^{6 7} The condition is overwhelmingly seen in women, with rates of 82-100%.^{6 8} The average age at presentation has ranged from 58 to 77 years.⁶

It is the shape of the left ventricle on imaging that gave rise to the name: a “tako-tsubo” is a traditional Japanese clay octopus trap that has the same characteristic shape as the “ballooning” ventricle, caused by reduced contractility of the mid-ventricular and apical segments and hypercontractile basal walls.¹ The most widely accepted diagnostic model is the Mayo criteria (see box).⁴

 

Mayo criteria for the clinical diagnosis of tako-tsubo cardiomyopathy 1. Transient akinesis or dyskinesis of the left ventricular apical and mid-ventricular segments with regional wall motion abnormalities 2. Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture 3. New electrocardiographic abnormalities (either ST segment elevation or T wave inversion) 4. Absence of: Recent significant head trauma Intracranial bleeding Phaeochromocytoma Obstructive epicardial coronary artery disease Myocarditis Hypertrophic cardiomyopathy

Most patients present with chest pain or dyspnoea, with rates approaching 68% and 18%, respectively. Patients can have pulmonary oedema, but reported rates have varied from zero to 46%.^{6 8} The latter series also reported the need for intra-aortic balloon pump insertion in 46% of patients—in excess of the experience in other institutions.^{4 8 9} Nevertheless, haemodynamic instability and cardiogenic shock are certainly possible complications.

The confusion with acute myocardial infarction is not only limited to the symptoms. The electrocardiogram typically shows ST segment elevation, most commonly in the anterior leads (up to 83.9% of patients). T wave changes and even pathological Q waves have been frequently seen.⁶ Cardiac enzyme changes suggest myocardial injury with increases in troponin concentrations in most patients. The troponin seems to peak earlier than in acute myocardial infarction, with highest values seen at presentation. However it is often much lower than one would expect with such extensive regional wall motion abnormalities.¹⁰ Increased concentrations of B-type natriuretic peptide (BNP) have also been seen.¹¹

The pathophysiology of the condition is as yet uncertain, although there are several theories. It is thought to be a catecholamine mediated injury in the context of low circulating oestrogen, perhaps explaining the prevalence in post-menopausal women—though it is far from exclusive to this group. Catecholamine concentrations are in excess of those seen in comparable acute myocardial infarctions¹² and animal models have shown reversibility of the changes with pretreatment with -adrenoreceptor blockade.¹³ The rat model has also shown a protective effect from oestradiol treatment in stress induced cardiomyopathy.¹⁴ Coronary artery vasospasm has been postulated—but the multivessel spasm, which would be required, has been reliably shown in very few patients.⁶ More likely is an abnormality in the microcirculation: measurement of flow rates during early coronary angiography has occasionally shown a reduction.¹⁵ The clinical picture does have similarities to the catecholamine mediated cardiomyopathy found in intracerebral and subarachnoid haemorrhage, also thought to be catecholamine mediated; however in these patients the apex is spared and it is the basal segment of the left ventricle that is hypokinetic.¹⁶ Myocarditis can also produce transient regional wall motion abnormalities but viral titres have been consistently negative in these patients.

A recent UK based series has postulated that the mechanism of injury is mediated not only through a catecholamine response, but also a left ventricular outflow tract obstruction. They found localised mid-ventricular septal thickening causing a mid-ventricular gradient, in effect dividing the ventricle into two. It is proposed that this results in distal subendocardial ischaemia, producing the characteristic changes. Dobutamine stress echocardiography reproduced the gradient, and may play some part in future diagnostic models.¹⁷

It is clearly difficult to differentiate between acute myocardial infarction and tako-tsubo cardiomyopathy and the clear consensus is that patients should initially be treated as the former.¹⁸ Currently, patients fulfilling criteria for ST elevation myocardial infarction should be referred for primary percutaneous intervention (PCI) or thrombolysis according to local guidelines. Early coronary angiography and the advent of primary PCI for acute myocardial infarction allows the identification of tako-tsubo cardiomyopathy and the possible prevention of unnecessary thrombolysis.

Pulmonary oedema due to left ventricular systolic dysfunction is often present and should be treated with supportive measures, nitrates and diuretics. β blockers have shown promise in reversing the “ballooning” of the left ventricle during simulations with dobutamine stress echocardiography and should probably be utilised.¹⁹ Angiotensin converting enzyme (ACE) inhibitors have been anecdotally shown to be effective, although no randomised prospective data yet exist.²⁰

The prognosis is good with return to normal left ventricle function in almost all patients, with recovery of normal performance.^{3 5 6 8} The rate of recurrence in the longest follow-up was low, at 11.4% over 4 years. However almost a third of patients had recurrent chest pain. Mortality was no higher than for an equivalent “normal” population.²¹

Tako-tsubo cardiomyopathy is an important differential of chest pain and indeed acute myocardial infarction, of which all acute physicians should be aware. However consideration of this uncommon diagnosis should not delay prompt reperfusion therapy. While its underlying pathophysiology remains unclear, future research may help develop more accurate diagnostic criteria and specific treatments.

 

Learning points Tako-tsubo cardiomyopathy is a differential diagnosis of chest pain It is most common in postmenopausal women It mimics acute myocardial infarction Treatment for ST elevation or non-ST elevation myocardial infarction should not be delayed while considering this diagnosis It requires coronary angiography to diagnose non-obstructive coronary artery disease The pathophysiology is unclear—but is likely to be catecholamine mediated There is no randomised control trial data for its management, which is currently symptomatic β blockers and ACE inhibitors may be useful

Cite this as: BMJ 2008;337:a107

Stem Cell Therapy…

I had the opportunity to be a “real” college student for a change and attend a lecture I was most interested in…the title: “The Promise of Embyronic Stem Cell Therapy: Euphoria or Ethical Quagmire.” By Nobel Prize Winner Dr. Mario Capecchi.

He did a great job of taking his area of expertise with all of the complexities, and in depth scientific parameters,  and “dumbing it down” for those of us not enlightened with the knowledge he possesses. I really was able to relate a lot of his research parameters and methodologies to what I am learning in Cell Biology.  Therefore, I thought it was a fabulous lecture.

Here are some of the highlights:

• There are primarily two main categories of stem cells used in research today…those with symmetric cell division (liver and blood vessels) and those with asymmetric cell division ( intestine, skin, blood). Within the two categories, two types of stem cells are considered: Embryonic and Adult. Embryonic stem cells grow rapidly, are versatile, and pluripotent; whereas, adult stem cells have slow growth processes, are restricted, and less controversial of the two stem cell variants.

• Adult stem cells are hard to use therapeutically because they are hard to isolate, difficult to purify, and have restricted differentiation potential. Also, they are programmed for apoptosis. However, the lessons that are important that are derived from adult stem cell research and utilization are: the discovery that many tissues have dedicated stem cells, stem cell division is slow, giving rise to fast rising off-spring.

• Embryonic stem cells, from the progenitor cell, can separate into many types of cells, whereas, the adult stem cells are already programmed to dedicate themselves to one specific type of function or growth pattern.

• Zones of differentiation = zones that make the cell different, that give the cell or a group of cells a specific functional responsibility. Zones of proliferation = zones that keep the cell dividing; living; progressing.

ETHICAL CONTROVERSY –

• The biggest controversy today is whether to use human embryos (those that are normally thrown out by fertility clinics) for study or to discard them. Over 20,000 early human embryos are discarded each year by fertility clinics.
• During the Bush administration, laws that restrict scientific study were implemented. Those laws allowed for older stem cells that were extracted prior to 1985 to be used. These are contaminated and not viable for medical treatment.
• Currently the isolation of human embryonic stem cells can occur in private companies but not in institutions that receive public funding (such as Universities). This is the worst possible scenario because no regulation occurs, no publication requirements defining research methodology and outcomes occurs, and no transparency occurs (there is no reference points for comparison, no open discussion about results and their application, and this is dangerous).

Dr. Cappechi said: “Knowledge is never evil in itself. Application of knowledge can be either good or bad, but for the application to result in good, it requires input from many fields, belief systems, political ideals, and general ideologies.”

Afterwards, I attended a “meet and greet” and I asked the following question: Do you use cell signaling within the cell cycle to determine the difference between the zones of differentiation and proliferation? The component of the response that I recall was: “There is some significance during mitotic and meiotic division for signaling to occur for these zones to enhance the job of the cell, but there is still so much we are not sure about in terms of the signaling process. We know signaling ties the zones together, but we are still determining the sequencing pathways that tie the process together while keeping them working as individual entities.” The answer had much more depth, but

It was an interesting lecture and discussion and has given me much to contemplate. I am an advocate of stem cell research and hope that some of the restrictions can be lifted so therapeutic advances can occur, although they may be long in the coming. I’d love to hear opinions about stem cell research…

Heart-Lung Pump In A Bypass Environment…

I am studying like mad for a Patho test on Thursday and have lots on my mind to blog about, but no time…thus, the filler. Hopefully you will find this as interesting as I did. I LOVE anything to do with heart/lung issues… Blessings and Light.