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Trombosis: A Very Brief Summary

a. Dr. Gleason started out his talk differently than most, he told the class his topic was not just business, rather it was personal to him. He told us about how he and his wife decided to adopt a child from Ethiopia, and her name was Kennedy, however, she sadly passed away before she could join the Gleason family. The reasons why she died could have been prevented in a developed country such as America, but Ethiopia 1 out of 6 children die before their fifth birthday.

Child mortality is a significant issue outside of the United states, and in 2010 over 8 million children died within 5 years of their birth, and about 50% of these children were in sub-Sahara Africa. After Dr. Gleason experienced this problem first hand, he decided to merge his research and his new passion for having a positive impact on the world. His research originally focused on the biomechanical field, but he shifted it to focus on global health, mainly HIV, and non-HIV comorbidities, reducing maternal mortality and improving child nutrition.

HIV is a relatively new disease, only being discovered in the 1980’s, and it was not until 1996 when an anti-retroviral therapy was developed. With today’s use of highly active antiviral therapy (HAART) HIV, when treated, is just considered a chronic illness as opposed to a life-threatening disease. However, Dr. Gleason and his team have found a connection between a commonly used HAART drug, Efavirenz (EFV), and medical markers that indicate the onset of cardiovascular diseases (CVD). His study was done on HIV patients in Ethiopia and there were 5 groups of 18-60-year-old HIV patients.

While EFV is commonly used due to its low cost and low toxicity, there is a significant correlation with medical markers associated with CVD. In order to combat this issue, one solution is to change the medication, however, this may prove to be difficult due to the high prescription rate that EFV has. Instead, doctors should be aware and give HIV patients on EFV regular CVD screenings, until another highly effective drug is made cheaper. Dr. Gleason then switched his topic to discuss the reduction of maternal mortality, especially in developing countries.

One of the main causes of maternal mortality is obstructed labor, which in the US typically results in a caesarean section but is difficult to perform in developing countries. In addition, it is currently difficult to identify high-risk pregnancies where the mother is likely to encounter an obtrusive labor and in developing countries, this is crucial so that the mother can find a hospital in advance to perform a C-section. Dr. Gleason and his research team are attempting to solve this problem by measuring the cephalometric disproportions (CDP) with a Kinect Xbox to determine if the pregnancies are high risk.

With the Kinect’s camera’s ability to do basic bone and joint mapping, the machine can be programmed to determine if a woman is at risk for an obstructed labor. b. The critical technological issue that Dr. Gleason and his team need to overcome in the next five years is the transfer of information. While Dr. Gleason was able to show the connection between HIV medicine and the early onset of cardiovascular diseases and how to identify high-risk pregnancies, he cannot help anyone unless he is able to communicate this information effectively across areas that are affected by this problem.

Many locations that have a high rate of HIV are rural, and only have access to EFV treatment, which is the main contributor to CVD, meaning it will difficult to both reach this population and develop a solution. If Dr. Gleason is able to communicate with enough doctors or medical groups in the area, then he will get his information across. Hopefully, these areas will screen HIV patients for CDV markers frequently, so that they can treat problems as they arise if they cannot change their medication.

Another group Dr. Gleason needs to communicate with is the World Health Organization (WHO), who can help spread the information and make sure patients and doctors are aware of the risks before they begin EFV treatment. c. According to the WHO, in 2015 there were an estimated 36. 7 million people in the world with HIV, 95% of the population being in developing countries, and of those only 18. 2 million were receiving antiretroviral treatment. Living with HIV has many costs, including treatment, but other costs are difficult to estimate, such as lost economic potential country experiences due to HIV.

One study indicated that developing countries in Africa experience a reduction in the average national economic growth rate by 2-4%, due to the decrease in labor supply, labor productivity, and reduced exports. With the help of EFV and other HAART treatment, the life expectancy for HIV patients is increasing, however, the mortality rate for non-HIV comorbidities are increasing. In developing countries, especially in Africa, 20% of deaths of HIV patients are due to CVD, which was developed due to the HIV treatment.

The WHO estimated the cost of deaths in sub-Saharan Africa to be $11. illion, which includes $4. 7 billion due to the reduction of productivity. By increasing screenings for CVD among HIV patients, and reducing the cost of other HAART treatments, sub-Sahara Africa has the potential to boost their economy by at least $11. 6 billion. d. Dr. Gleason stood out from every other we have had so far because of his personal connection with his research. Many other speakers got into their field because they could get a grant or they just happened upon that field, however, Dr. Gleason began his research in bioengineering and global health because of the connection to his family.

He started his presentation by telling the class about the first daughter that he and his wife tried to adopt, but she, unfortunately, passed away before she could join their family. It was because of this Dr. Gleason began connecting his previous research to global health, which led him to do more research into HIV and non-HIV co-morbidities, reducing maternal mortality and improving child nutrition. Throughout his whole presentation, it was easy to see how passionate Dr. Gleason was and that he truly wanted his research to positively impact as many people as possible.

So far he has been one of my favorite speakers because of his personal connection to his topic. 2. Role of high shear rate in thrombosis a. Dr. Ku’s first major point of this article is that thrombosis is and why it is so dangerous to humans. Thrombosis is an arterial disease that results in the clotting of blood in various parts of the circulatory system. When this phenomenon is encountered in a patient who is suffering from a life-threatening hemorrhage, thrombosis can stop the bleeding, therefore, saving lives.

However, when this occurs outside of those conditions, the patient is in danger and can result in a stoppage in blood flow. The second major point in the article is the effect of shear rate on thrombosis. In vessels, the blood flows fastest in the center and its velocity reaches zero at the vessel walls, and the wall shear rate is equal to the near-wall velocity divided by (y). When the high shear rate is coupled with a condition such as a stenosis, or the narrowing of arterial vessels, the rates can increase 400 times the normal amount and can lead to thrombosis.

The third major point of the article is the effects of vWF on thrombosis. In order for thrombosis to form platelets must attach to the vessel wall through an adhesive surface and protein such as vWF, which is the preferred protein for platelets to bond with. The platelets in the blood vessel are more likely to bond to the walls when paired with stenosis, high shear rate, and vWF, thus creating the perfect conditions for thrombosis. Dr. Ku’s fourth major point of the article is the clinical implication that comes as a result of his findings, mainly altering medical device’s placement and materials.

According to the article, high shear locations occur with vascular grafts, arteriovenous fistulas, endovascular aneurysm repairs and centrifugal pumps. By avoiding placement in or by correction these stenotic regions that might require one of the devices above, the risk of high shear regions is greatly diminished. Another way to reduce the risk of thrombosis is to choose materials for medical devices that have a minimal protein absorption rate, particularly vWF. Materials that are passivated with hydrogels or other similar coatings have lower thrombogenic potential.

As more doctors and scientists become aware of the connection between high shear and thrombosis, device design and testing will be changed to take high shear risk into account. Eventually, the FDA might change their regulations to require materials and device with low thrombogenic potentials. b. The breakthrough technology in this paper is the better understanding of high shear rates and how they affect thrombosis in patients. While other research focused on the low shear rate and its effect on coagulation blood clotting, this research focuses on the less understood subject of high shear rate.

Thrombosis can save lives when patients encounter a trauma that causes hemorrhage and thrombosis stop the bleeding, however, outside of these circumstances, thrombosis is dangerous and not well understood. The new trails and research have produced evidence that the von Willebrand factor (vWF) induces the binding of platelets, which hastens the onset of life-threatening thrombosis. VWF is the longest protein in biology, about 67x bigger than the average protein length, and is the preferred binding agent for platelets.

Because of this better understanding of what factors affect thrombosis doctors can avoid medical devices or treatments that can lead to a higher risk of high and low shear rate, both of which cause life-threatening conditions. c. An application that comes from the newly found understanding of thrombosis is the ability to select a better medical device implant for patients based on device location and material. It is known that endovascular aneurysm repairs, vascular grafts, arteriovenous fistulas, and centrifugal pumps cause high shear conditions in a patient’s body, which leads to thrombosis.

To avoid creating high shear rates, doctors can avoid stenotic and other regions that create high shear. One way to achieve lower local shear is by utilizing the practice of bypass grafting, angioplasty or stent placements. In additional to being aware of medical device placement, this paper indicated doctors should also be aware of the device material. Certain materials used in vascular grafts are capable of minimizing protein absorption, particularly vWF. Materials that are passivized with hydrogen or other coatings can lower the thrombogenic potential but decreasing VWF absorption.

The next step after using this data to create a better device or material is to incorporate the requirements for materials with low thrombogenic potential into FDA regulations. d. Based on Dr. Ku’s research, a potential product that can be created would be a new cardiovascular medical device that can be implanted without the fear of creating high shear rates, thus diminishing the likelihood of thrombosis. Such a medical device would follow the materials selection process outlined in the paper and using coatings such as hydrogels to prevent vWF absorption.

By changing the material of the device and lowering vWF absorption, the chance of Thrombosis accusing would decrease significantly. The cardiovascular device market had $42 billion in sales during 2015, and if the company manufacturing this product were only able to capture 1% of this market, it would still yield a profit of $420 million. Currently, the leading device manufacturer in the market is Medtronic, whose sales of cardiovascular devices makes up 46% of their business. Not only is this market already profitable, but experts believe that the market will increase in the future due to the rising diagnoses of cardiovascular diseases.

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