Tino Explore Issue 2 (22-23)

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ISSUE 2 | NOVEMEBER 2022 In this issue: Learn about the role of recent advancements in 3D printing in the healthcare industry Take a look at how renal denervation, a recently discovered procedure, could help reduce blood pressure. The medical industry is evolving every day. Learn about recent live-saving advancements in the healthcare sector. PERSONALIZEDHEALTHCARE WITH3DPRINTING KIDNEYTREATMENTFOR HYPERTENSIVEPATIENTS

Contents.

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New advancements in 3D printing have allowed doctors to implement it into healthcare practices and improve patient safety. Learn more about the myriad of applications that could be used in the future

Kidney Treatment for High Blood Pressure

Patients

For many years, chronic kidney disease has been debilitating to its patients but with renal denervation, a recently discovered process that could alleviate some of symptoms, a much-needed solution may be on the horizon.

Cancer Pharmacology: Any new hope for cancer patients?

Learn more about cancer pharmacology, the study of molecular and cellular mechanisms that could unlock new treatments such as VEGF therapy

Treatments for Alzheimer's: A Light at the End of the Tunnel

Explore a timeline of history of alzheimer's from its initial discovery to possible cures that can reduce cognitive and functional decline in patients.

Pigment can be found in almost every human product. Learn about how some of these were discovered to be poisonous and their consequences.

6 Cancer Pharmacology: Any new hope for cancer patients?

Learn more about cancer pharmacology, the study of molecular and cellular mechanisms that could unlock new treatments such as VEGF therapy

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Personalized Healthcare with 3D Printing
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Issue 1 (22-23): The Intersection of Art & Science Check out our previous issues at: tinyurl.com/exploremag Issue 4 (21-22): Our Planet, Our Duty

Personalized Healthcare with 3D Printing

3D printing is an up-and-coming form of technology where anything from food to custom art projects can be created. Its versatile nature allows it to be applied to a variety of fields, one such example being healthcare – with 3D printing, there is a further emphasis on individualized care for patients including structural models, orthopedic implants and medicine.

Doctors mainly use 3D printing to create a customized structure that is specific to its patient. For example, before a surgery, a model of the patient’s spine can be made in order to locate the parts of interest. Other anatomyrelated models such as bones and teeth have been created, and 3D-printed knee replacements even have permeable structures which help encourage tissue growth.

Many of these structures are printed using metals and plastics, which are the most common materials used, but thermoplastics like polycarbonate and lactic-based polymers like PLA and PCL are also used in healthcare. These products are created using uploaded files that can be easily altered to match the desired proportions; this is a stark contrast to the previous use of carbon fiber molds or patterns.

Furthermore, models can be printed as a single piece with little to no need for assembly. Having a physical structure to show exactly what is being operated on dispels any questions that would otherwise be difficult to answer without visuals. Therefore, not only does this allow for greater accuracy and ensures safer surgical results, but the added benefit of a physical structure eases communication between the doctor and patient.

Written

Its uses are not limited to patient-specific models, however New medical devices and instruments can be manufactured easily by accelerating “the design process by iterating complex designs in days instead of weeks,” according to the guide Introduction to Medical 3D Printing and 3D Printers for Healthcare by formlabs com Scientists have also been working towards the creation of a medicine that combines the uses of several pills into one, or “enable[s] slower or faster absorption.”

There have even been attempts to recreate cell tissue, but these developments have been fairly new

It isn’t a surprise how many medical facilities have taken advantage of these tools – according to Pew Trusts, the number of hospitals in the United States that use 3D printing has increased from “3 in 2010 to more than 100 by 2019.”

However, although there have been successes using 3D printing in healthcare, it will be a while before it can become a mainstream tool. The most significant factor is the Food and Drug Administration (FDA), which places heavy regulation on products to ensure no one is harmed short or long term

They are sorted into different categories –Classes I, II and III – which more or less determines the number of safety tests it will have to pass before being used on a larger setting

Class I to II products, such as structural models, have minimal to moderate risk to the patient’s health. Class III products include pacemakers and implants which could potentially be life-threatening if they are defective In contrast, 3D printing software programs are often approved as it is ultimately the responsibility of the user to take extra precautions with them.

Regardless, these obstacles can eventually be bypassed with more refinement. 3D printing is an exciting concept in of itself, and when healthcare comes into it, wonderful contributions can be made for the benefit of our society.

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KIDNEYTREATMENT

FORHIGHBLOODPRESSUREPATIENTS

Writtenby:AahelieB,Edited&Researchedby: PruthaK,Designedby:ClarabelleW

FORPATIENTSLIVINGWITHCHRONIC KIDNEYDISEASE,SYMPTOMSSUCHAS UNCONTROLLABLEHIGHBLOOD PRESSURE,CHESTPAINS,AND DETERIORATINGMENTALSHARPNESS BECOMEANUNAVOIDABLEPARTOF LIFE,DUETOAGRADUALLOSSOF KIDNEYFUNCTION.WHILETREATMENT CANSLOWTHEPROGRESSIONOFTHE DAMAGE,THEDISEASEMAYSTILLLEAD TOEND-STAGEKIDNEYFAILURE WITHOUTARTIFICIALFILTERING (DIALYSIS)ORAKIDNEYTRANSPLANT. HOWEVER,THEREISADISCUSSION SURROUNDINGTHEPOSSIBILITYOF PERMANENTLYLOWERINGBLOOD PRESSURELEVELSBYBURNINGNERVES AROUNDTHEKIDNEYUSING RADIOFREQUENCYPULSES.MOREOVER, THETREATMENTCOULDBEINCREDIBLY HELPFULFORTHOSEWITHRESISTANT HYPERTENSION,ORHIGHBLOOD PRESSURETHATHASNOTRESPONDED TOMEDICATION. TOUNDERSTANDTHISPROCESS,WE MUSTFIRSTUNDERSTANDTHEKIDNEY ANDITSCOMPLEXNETWORKOF SYMPATHETICNERVES.THEKIDNEYS’ NERVESHAVEBEENKNOWNTO REGULATEBLOODPRESSUREFOR DECADES.SYMPATHETICNERVES ALLOWTHEBODYTOJUMPINTO “FIGHT-OR-FLIGHT”MODE.INTUITIVELY,

THISSYSTEM'SACTIVITYINCREASES WHENYOUARESTRESSED,INDANGER, ORPHYSICALLYACTIVE.THISISWHY STRESSANDUNCONTROLLED REACTIONSTOSTRESSMAY EVENTUALLYLEADTOKIDNEYDAMAGE. IFTHEKIDNEYSARENOTFUNCTIONING ASPERUSUAL,EXTRACELLULARFLUID ANDWASTEPRODUCTSMAYBUILDUP INYOURBODY.THEFUNCTIONOFTHE KIDNEYSISTOCONTROLBLOOD PRESSUREBYFILTERINGWATERAND SALTFROMTHEBLOODANDTO PRODUCEHORMONESINVOLVEDIN CONTROLLINGBLOODPRESSURE.IF YOURKIDNEYSAREN'TWORKING PROPERLY,FLUIDANDWASTE PRODUCTSCANBUILDUPINYOUR BODY.

THEPROCESSWEAREDISCUSSINGIS KNOWNASRENALDENERVATION.IT INVOLVESINSERTINGACATHETERINTO THETHIGH’SFEMORALARTERYTO ACCESSTHEARTERIESTHATFEEDTHE KIDNEYSANDAPPLYINGRADIOWAVE PULSESTOBURNTHENERVESINTHE ARTERYWALLSANDREDUCETHEIR ACTIVITY.EXACTLYHOWRENAL DENERVATIONWORKSISN’TWELL UNDERSTOODYET. HOWEVER,SOFAR,BOTHPROSAND CONSHAVEBEENPINPOINTED.FOR EXAMPLE,WHILETHISTECHNIQUEHAS SHOWNPROMISEASATREATMENTFOR HIGHBLOODPRESSURE,THEREISALACK OFDATAONITSSAFETYANDLONG-TERM EFFICACY.THEPROCEDURE'SRISKS INCLUDETHEHEARTRATESLOWING DURINGTHEPROCESS,NARROWING RENALARTERIES,POSSIBLEBRUISINGAT THEPUNCTURESITE,ANDTEARINGOF RENALARTERIES.TOEXPLOREFURTHER, FELIXMAHFOUDATSAARLAND UNIVERSITYINSAARBRÜCKEN,GERMANY, ANDHISCOLLEAGUESSTUDIED80PEOPLE WHOHADHIGHBLOODPRESSURE, DESPITETAKINGANTIHYPERTENSIVE DRUGS,OVERTHREEYEARS.38OFTHE PARTICIPANTSUNDERWENTRENAL DENERVATIONANDTHECONTROLGROUP OF42HADAFAKEPROCEDURE.ATTHE OUTSET,ALLTHEPARTICIPANTS’SYSTOLIC PRESSURE(THEFORCEATWHICHTHE HEARTPUMPSBLOODAROUNDTHEBODY) WASBETWEEN150-180MMHG (ANYTHINGABOVE140MMHGIS GENERALLYCONSIDEREDHIGH).THEIR DIASTOLICPRESSURE

(THERESISTANCETOBLOODFLOWIN THEBLOODVESSELS)WASGREATER THAN90MMHG,WHICHISAHEALTHY READING.BYTHEEND,THE PARTICIPANTS’SYSTOLICAND DIASTOLICBLOODPRESSUREREADINGS WERE10MMHGLOWER. COMPARATIVELY,THESHAMGROUP’S READINGSWEREREDUCEDBY5.9 MMHG. ACCORDINGTOTONYHEAGERTYAT THEUNIVERSITYOFMANCHESTER,UK, “THENUMBERSAREQUITESMALLINTHIS PAPER,BUTITDIDLOOKASIFRENAL DENERVATIONLOWEREDBLOOD PRESSUREMORETHANTHESHAM CONTROL,”. TOCONCLUDE,THEPROCESSOFRENAL DENERVATIONSHOULDCONTINUETO DEVELOPINORDERTOMENDTHE DOWNSIDESTHATCURRENTLYEXIST. HOWEVER,THEIDEAHASTHEPOTENTIAL TOBEALIFE-CHANGINGPROCEDURE FORTHOSEWHOSTRUGGLEWITHHIGH BLOODPRESSURE.

CancerPharmacology:Anew hopeforcancerpatients?

What is Cancer Pharmacology?

Cancer pharmacology is the study of the molecular and cellular mechanisms of cancer cells and the identification of novel therapeutic targets and treatment strategies. Its main goal is finding new molecular targets for destroying cancer cells and to discover and develop more effective cancer treatments. One of its recent breakthrough findings is VEGF therapy.

What is Cancer Pharmacology?

Cancer pharmacology is the study of the molecular and cellular mechanisms of cancer cells and the identification of novel therapeutic targets and treatment strategies. Its main goal is finding new molecular targets for destroying cancer cells and to discover and develop more effective cancer treatments. One of its recent breakthrough findings is VEGF therapy.

Unfortunately, this treatment is not perfect. Although traditional VEGF medications such as VEGF inhibitors are an effective anti-cancer therapeutic agent, these medications can be bad for blood pressure and cardiovascular health according to recent findings during a session at the American Society for Nephrology Kidney Week conference.

Hypertension, or having high blood pressure, is one of the primary causes of chronic kidney disease, which is especially concerning when considering that kidneys are the primary long-term controllers of blood pressure control in the body.

High blood pressure also has many other detrimental effects on the body, such as cardiovascular disease and heart failure. Data from the International CardioOncology Society found that very high blood pressure was associated with acute hypertensionmediated organ damage to the heart, brain, and kidneys, while reducing high blood pressure lowers the risk of organ damage. Although VEGF treatment has not been perfected, it remains a promising leap forward to unraveling the mystery — Cancer.

Bevacizumab: monoclonal antibody (antibody that recognize a single epitope within a given antigen) Ranibizumab: antibody fragment (antibody that recognize multiple epitopes within a given antigen) Aflibercept: fusion protein

TREATMENTS FOR ALZHEIMER’S: A LIGHT AT THE END OF THE TUNNEL

Introduction What is Alzheimer's?

Across the globe, around 50 million people are currently living with Alzheimer’s, an illness that gradually progresses and ultimately hinders the everyday tasks of the patient With this number on the rise, in recent years, scientists have made it a priority to delve deeper into research on ways to treat and potentially cure this deadly disease Over the years, scientists have managed to make new breakthroughs and create treatments that have bettered the lives of millions, each marking a new step into finding a cure

Alzheimer’s Disease is a common type of dementia that usually affects older adults, a condition that harms the brain by affecting memory, thinking, and behavior The most common symptom is memory loss, which ultimately disrupts daily life and causes behavioral and personality change As the brain neurons continue to die, the symptoms progressively worsen, typically ending with most patients getting admitted to long-term care facilities. In the early stage of Alzheimer’s, the patient develops poor memory, with regards to previously familiar objects, places, events, and conversations This causes repetitive questioning and decreased judgment and reasoning In the middle stage, the symptoms include difficulty speaking, confusion and disorientation, mood swings, and disturbed sleep Finally, during the late stage, the patient will begin to experience severe weight loss, difficulty with moving and eating, as

well as short and long term memory issues

Through the progressive worsening of Alzheimer’s, the brain undergoes significant changes. In a healthy adult brain, there are about 100 billion neurons, each with synapses that connect with other neurons These synapses send signals that form memories, thoughts, sensations, and skills Even when aging, neurons are not lost in large numbers However, in the brain of a patient with

Alzheimer’s, the neurons stop functioning and lose connections to other neurons, due to an abnormal buildup of protein These proteins include amyloid which forms plaque and tau which forms tangles within the brain cells This causes a significant loss of neurons when aging and leads to fatality

As one of the top 10 leading causes of death in the U S and the 6th greatest cause of death among U S adults, there are currently

almost 5 8 million Americans living with Alzheimer’s disease Experts have estimated that this number will double every 5-10 years, reaching 14 million people by 2050 With age being the biggest risk factor for Alzheimer’s, the majority of patients are over 65 years of age, as the risk doubles every five years after the age of 65 And after the age of 85, the risk percentage reaches 33 percent Another factor that contributes to Alzheimer’s is family history, as it is more likely for individuals whose sibling or parent

has had Alzhimer’s to get diagnosed with the disorder. Genetics also plays a big role in the cause of Alzheimers; In fact, between 40 to 50 percent of diagnosed Alzheimer’s patients have a gene called APOE-e4 inherited from their parents Additionally, some preventable factors include head injury and heart health To lower the risk of Alzheimer’s, one should exercise regularly, eat nutritious, healthy foods, and use standard precautionary measures to prevent head injury

TIMELINE BREAKTHROUGHS

BREAKTHROUGHS AND DISCOVERIES MADE IN RESEARCH IN ALZHEIMER'S

DR ALOIS ALZHEIMER NOTICED CHANGES IN BRAIN TISSUE TO A WOMAN, AUGUSTE D WHO SUFFERED MENTAL ILLNESS WITH SYMPTOMS RANGING FROM MEMORY LOSS TO LANGUAGE PROBLEMS AFTER CLOSER EXAMINATION, HE FOUND ABNORMAL CLUMPS AND TANGLED FIBERS, THE AMYLOID AND TAU PROTEINS

BETA-AMYLOID, THE KEY COMPONENT OF ALZHEIMER’S BRAIN PLAQUES AND THE POTENTIAL CAUSE OF NERVE CELL DAMAGE, WAS IDENTIFIED

1906 1984 1986

1987

FIRST ALZHEIMER’S DRUG TRIAL TOOK PLACE, PFIZER (THEN CALLED WARNER-LAMBERT PHARMACEUTICAL COMPANY) LAUNCHED + RECRUITED PARTICIPANTS FOR CLINICAL TRIALS FOR TACRINE, THE FIRST DRUG TO TARGET SYMPTOMS

2021

ADUCANUMAB WAS APPROVED FOR THE TREATMENT OF ALZHEIMER’S IT WAS THE FIRST THERAPY TO REMOVE BETA-AMYLOID IN ORDER TO REDUCE COGNITIVE/FUNCTIONAL DECLINE IN PEOPLE WITH EARLY ALZHEIMER’S

1968

COGNITIVE MEASUREMENT SCALES WERE DEVELOPED, WHICH ALLOWED RESEARCHERS TO ASSESS COGNITIVE FUNCTIONAL DECLINE THROUGH ESTIMATING THE NUMBER OF BRAIN LESIONS AND THE AMOUNT OF DAMAGED TISSUE.

TAU PROTEIN, THE MAIN COMPONENT OF TANGLES AND PRIME SUSPECT OF NERVE CELL DEGENERATION WAS DISCOVERED

1993

FDA APPROVED THE FIRST DRUG, TACRINE TO TREAT ALZHEIMER’S AS THE FIRST DRUG SPECIFICALLY TARGETING ALZHEIMER'S MEMORY AND THINKING SYMPTOMS

Conclusion

These new breakthroughs and discoveries that have recently been made serve as a light at the end of the tunnel, a sign that one day, with hope we will come up with a means of curing this cruel neurodegenerative disorder

While Alzheimer’s has plagued millions, in past years, scientists have made considerable progress in treating patients of Alzheimer’s through developing treatments for a previously terminal disease Though a cure remains to be found, these new breakthroughs and discoveries that have recently been made serve

as a light at the end of the tunnel, a sign that one day, with hope we will come up with a means of curing this cruel neurodegenerative disorder that has robbed so many people of their memory of loved ones and their ability to independently perform basic actions

Memantine

Decreases effects of symptoms, including ability to usebathroomindependently Regulates glutamate, a chemicalthatkillsbraincells Commonsideeffects: Bloating or swelling of the face, arms, hands, lower legs,orfeet blurred vision, dizziness, headache

for mild-moderate symptoms
for moderatesevere
for Alzheimer's Preventsbreakdownofacetylcholine,whichisimportantforthinkingand memory Tabletstakenonceortwicedaily Sideeffects: Nausea,diarrhea,vomiting Fatigue,dizziness,headache
As devastating as Alzheimer’s is, treatments have been used to mitigate the symptoms of the disease However, it is important to note that these don’t prevent the disease or cure it; instead they lessen the effects of the symptoms Treatments
Treatments
Treatments
Cholinesteraseinhibitors
ApprovedbyFDAlastyear Reducesamyloidplaques(brainlesionscausedbyAlzheimer’s) Administeredeveryfourweeks Side effects include brain swelling (changes in mental status, headaches,vomiting),brainbleeding,confusion Stilldebateabouteffectiveness Some small trials have shown that it decreases symptoms and preventsformationofamyloid Aducanumab

Artificial Intelligence

Artificial intelligence is coming to the medical field and it is bringing with it a new way of diagnosing and treating patients. Artificial intelligence can work on its own or in cooperation with other doctors. It can also work on its own, providing assistance to doctors by analyzing patient records, drawing conclusions and suggesting diagnoses. This technology has shown a great potential in the medical field. It can help doctors diagnose diseases more quickly and accurately while saving time that would have been spent on research. It can also be used for surgeries, assisting surgeons by performing tasks like cutting tissue or cauterizing blood vessels. artificial intelligence is coming to the medical world and it brings with it many benefits for patients, doctors and even insurance companies who save money by using artificial intelligence instead of humans for diagnosis and treatments.

To start off, artificial intelligence improves the lives of patients, doctors, and hospital administrators by completing activities normally performed by humans, but at a fraction of the time and cost. For example, artificial intelligence supports physicians to make recommendations by evaluating vast amounts of health data such as electronic medical records, symptom data, and physician reports to improve health outcomes and ultimately save patients’ lives (Kohlberger et al., 2019). Furthermore, this data helps improve and accelerate decision-making when using AI-based methods to diagnose and treat patient conditions. Additionally, artificial intelligence assists physicians in disease detection by leveraging sophisticated algorithms, hundreds of biomarkers, imaging findings from millions of patients, aggregated published clinical studies, and thousands of physician notes to improve diagnostic accuracy.

Using artificial intelligence in medical records can help identify patterns and predict outcomes. This information can then be used to tailor specific treatments to individuals, even down to a level of granularity best suited to physicians who meet the needs and outcomes most important to them. As a practical example, especially in the early stages of the pandemic, patients with pre-existing but unrelated conditions to COVID-19 could be matched with available caregivers based on the data and outcomes they observed across providers. This may help them avoid long waits, or for routine health checks when their general practioner is unavailable due to office closures. This improves not only patient outcomes, but individuals' access to care.

Ultimately, it is crucial that this technology is accessible to all patients and doctors in order for it to be successful. Doctors should have access to these tools at their fingertips and patients should be able to access these tools from their own homes in order for them to get the best treatment possible.

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Sources.

Alzheimer's Association. (2020). On the Front Lines: Primary Care Physicians and Alzheimer’s Care in America. https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf Alzheimer's Association. (2019). Milestones. Alzheimer’s Disease and Dementia. https://www.alz.org/alzheimers-dementia/research progress/milestones Center for Devices and Radiological Health. “3D Printers Are Used to Manufacture a Variety of Medical Devices.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/medicaldevices/3d-printing-medical-devices/medical-applications-3d-printing. Centers for Disease Control and Prevention. (2020, October 26). Alzheimer’s Disease and Related Dementias CDC https://www cdc gov/aging/aginginfo/alzheimers htm Health, C (2022, February 18) 2022 Alzheimer’s Cure Breakthrough Cano Health https://canohealth com/news/blog/2022-alzheimers-cure-breakthrough/ “Introduction to Medical 3D Printing and 3D Printers for Healthcare ” Formlabs, https://formlabs.com/blog/3d-printing-in-medicine-healthcare/. Memantine (Oral Route) Side Effects - Mayo Clinic. (n.d.). Www.mayoclinic.org. https://www.mayoclinic.org/drugs-supplements/memantine-oral-route/side-effects/drg20067012?p=1

National Institute on Aging. (2018). How Is Alzheimer’s Disease Treated? National Institute on Aging. https://www.nia.nih.gov/health/how-alzheimers-disease-treated National Institute on Aging. (2017, May 16). What Happens to the Brain in Alzheimer’s Disease? National Institute on Aging. https://www.nia.nih.gov/health/what-happens-brain-alzheimersdisease NHS. (2021, July 5). Causes - Alzheimer’s Disease. NHS. https://www.nhs.uk/conditions/alzheimers-disease/causes/ NHS Choices. (2022, January 28). Symptoms - Alzheimer’s disease. NHS. https://www.nhs.uk/conditions/alzheimers-disease/symptoms/ Renal denervation –. (2018, October 3). CIRSE. Retrieved October 21, 2022, from https://www.cirse.org/patients/ir-procedures/renal-denervation/ The Pew Charitable Trusts. “What Is Medical 3D Printing-and How Is It Regulated?” The Pew Charitable Trusts, The Pew Charitable Trusts, 5 Oct. 2020, https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/10/what-is-medical-3dprinting-and-how-is-it-regulated Treating Hypertension With Renal Nerve Ablation (2021, October 1) DAIC Retrieved October 21, 2022, from https://www dicardiology com/article/treating-hypertension-renal-nerveablation

Wilkins, A. (2022, April 4). High blood pressure may be treated by burning nerves near the kidneys. New Scientist. Retrieved October 21, 2022, from https://www.newscientist.com/article/2314762-high-blood-pressure-may-be-treated-byburning-nerves-near-the-kidneys/ World Health Organization. (2022, September 20). Dementia. World Health Organization; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/dementia

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