CTB10 - New and Future Developments

Question 1

Name some factors that are changing globally, which may impact cardio respiratory conditions.

Answer 1

Environmental pollution.
Smoking.
Diet.
Ageing population.
Technology

Question 2

Discuss the advantages and disadvantages associated with technology in healthcare.

Answer 2

Advantages - can make healthcare more accessible, in terms of delivery andmonitoring
Disadvantages - effect of non compliance can increase with increasing social media.

Question 3

Discuss alternative and complementary medicine.

Answer 3

Use of non standard healthcare I.e. acupuncture, herbal medicines, home treatments

Question 4

Define precision medicine,

Answer 4

Also referred to as personalised medicine. Involves the targeting of medical treatments to specific sub populations within a disease population. Can make treatment processes more beneficial.

Question 5

What kind of processes will be personalised during personalised medicine?

Answer 5

Customisation of medical practices. Diagnosis. Decisions. Treatments. Products.

Question 6

What kind of patient specific products may be designed as part of personalised medicine?

Answer 6

Patient specific tissues or organs built from patients own cells.

Question 7

Describe the process from one size fits all medicine to stratified medicine to precision medicine.

Answer 7

From one size fits all medicine to stratified medicine requires stratification - disease population grouped into sub populations based on demographics, clinical features and bio markers.
Stratified medicine to personalised medicine requires personalisation - individual preferences considered, genetic profile, medication history, environment, behaviour, habits.

Question 8

What are three factors that are considered when identifying sub populations within a disease population?

Answer 8

Disease susceptibility.
Disease prognosis/biology.
Response to treatment

Question 9

Give a brief overview of the process of drug development.d

Answer 9

Many thousands of compounds originally screen during stage 1 drug discovery which involves in vitro testing. Hundreds of these are taken to pre clinical development stage 2 which involves animal testing. A handful of these are taken to stage 3 clinical development with human testing (5 phases within this). One compound may come out of this which needs to undergo regulatory approval. Overall process for each drug can take approx 15 years and 3 billion dollar.s

Question 10

Discuss the advantages and disadvantages of in vitro testing during pre clinical development.

Answer 10

Advantages - easy to do, can be reproducible between different laboratories around the world.
Disadvantages - inefficient, does not display true behaviour of the drug, time consuming.

Question 11

Discuss advantages and disadvantages of animal testing.

Answer 11

Advantages - may be representative of how drug effects humans also, relatively cheap,
Disadvantages - not ethical to test on animals,animal disease model does not fully indicate how disease behaves in humans.

Question 12

What issue do organs on chips hope to overcome? How does it do this?

Answer 12

Use of animal testing. Organ on chip behaves as artificial human that can be used for testing.

Question 13

Give four advantages of the organ on a chip system.

Answer 13

Multiple drug testing is more readily doable.
Reduced experimental use of animals.
Personalised medicine more accessible.
Drug toxicity can be evaluated prior to administration.

Question 14

Discuss briefly the structure of an organ on a chip, using the pulmonary artery on a chip as an example.

Answer 14

Microscopic sized channel crested with polydimethylsiloxane used to make chambers and membranes. One side of membrane contains endothelial cells and other contains smooth muscle cells. Blood flow is stimulated within the chamber.

Question 15

Define bioprinting.

Answer 15

Printing of 3D images using living cells as the ink for printing.

Question 16

Define bio fabrication.

Answer 16

Use of technology and engineering to produce tissues and organs.

Question 17

What are some problems currently associated with bioprinting?

Answer 17

Formation of blood vessels and intercellular connections.

Question 18

Give one example of the use of bioprinting within a human patient.

Answer 18

Production of airway splint from bioresorbable plastics. Used in 3 month old baby to hold airway open ensuring sufficient breathing.

Question 19

What current transplantation issues could bioprinting potentially alleviate?

Answer 19

Rejection of transplant organ - if organ being transplanted is made from patients own cells, reduces risk of rejection, if any. Removes need for use of immunosuppressants.
Lack of transplant availability - transplant list is ever growing however donor list is not. Using own patients cells may mean that waiting times are reduced.

Question 20

What two processes may be combined alongside bioprinting to deliver modified cells via therapeutic means?

Answer 20

Gene transcription and drug delivery.

Question 21

Discuss the potential use of bioprinting on the patient.

Answer 21

Direct bioprinting on the patient may be used for direct wound repairing. Requires use of growth factor and other biomaterial scaffolds.

Question 22

What are eNoses and how have they been developed to work efficiently?

Answer 22

Electronic noses that are able to recognise and detect specific smells. Use a current database to match the smell to one that is already known and has been previously identified.

Question 23

Give a use of the eNose in a clinical setting.

Answer 23

Can be used to detect respiratory disease. Can be extremely helpful for early detection.

Question 24

What two lung disease can most commonly be differentiated between using eNose?

Answer 24

COPD and asthma

Question 25

In addition to COPD and asthma, what other types of lung diseases are more recently being distinguished via eNose?

Answer 25

Lung cancer - eNose detects volatile organic compounds within the exhaled air and matches to a type of cancer.
Viral and bacterial infections - can be used to identify the specific type of COPD exacerbation.

Question 26

Discuss the use of the iKnife in cancer surgical procedures.

Answer 26

Cutting tool is heated and brought into contact with the cancerous cells. Rapid evaporative ionisation mass spectrometer (REIMS) used to chemically analyse the smoke produced from the hot cutting tool. Presence or absence of cancer cells is detected and information relayed to surgeon. Allows easy detection of cancer vs non cancer.

Question 27

What are three major areas within cardio respiratory medicine that are currently being researched?

Answer 27

More accurate diagnostics processes.
New therapies and delivery devices.
Artificial intelligence and machine learning.

Question 28

What is diagnostics? Discuss its importance in precision medicine.

Answer 28

Diagnostics refers to the process by which a disease can be diagnosed within a patient. Can be particularly useful in personalised medicine to detect sub populations within a disease population,

Question 29

What are LRTIs and why is diagnostics important within this area of medicine?

Answer 29

LRTIs are lower respiratory tract infections. Many different types are apparent but are difficult To diagnose and distinguish. Additional processes are being built to distinguish between them ,ensuring that more accurate treatment processes can be performed

Question 30

What other parameters may be used for diagnostics?

Answer 30

Current parameters used need to be fine tuned or new parameters need to be considered. E.g. respiratory diseases can be identified using FEV1/FVC ratios and patient reported outcomes however these can be refined

Question 31

What are three current difficulties associated with drug delivery?

Answer 31

Delivery to optimal region within the system.
Delivery to region at optimal concentration.
Prevention of unwanted side effects - E.g. by preventing drug entering systemic circulation

Question 32

Discuss the use of tracking patient medication adherence and its importance.

Answer 32

Tracking patient adherence can be used to determine if the medication is having an effect or not. If patient not using medication, perhaps another medication could be trialled. Costs associated with healthcare may also be reduced.

Question 33

Discuss what green healthcare is.

Answer 33

Use of environmentally friendly processes within the field of healthcare. E.g. use of disposable plastic inhalers for respiratory conditions

Question 34

Discuss the two potential uses of AI and machine learning during CT scans.

Answer 34

Improving obtaining the CT scan images. Improving interpreting the CT scan images.

Question 35

Discuss the role of AI and machine learning in iKnife and eNose?

Answer 35

IKnife - can be used to distinguish between cancerous and non cancerous cells.
ENose - can be used to distinguish between different smells.