What the NHS is all about!

 

A bit of history….

The NHS officially came into being in July 1948, in the wake of World War II, to replace an inadequate system of volunteer hospitals that had, during the war, come to rely on government funding. Doctors and conservative politicians vehemently opposed the NHS in the run-up to its formation. When it was launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was based on three core principles:

  • that it meet the needs of everyone
  • that it be free at the point of delivery
  • that it be based on clinical need, not ability to pay

These three principles have guided the development of the NHS over more than 60 years and remain at its core.


In March 2011, the Department of Health published the NHS Constitution. It sets out the guiding principles of the NHS and the rights of an NHS patient.

The seven new key principles guide the NHS in all it does:

  1. The NHS provides a comprehensive service available to all
  2. Access to NHS services is based on clinical need, not an individual’s ability to pay
  3. The NHS aspires to the highest standards of excellence and professionalism
  4. The NHS aspires to put patients at the heart of everything it does
  5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.
  6. The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources.
  7. The NHS is accountable to the public, communities and patients that it serves

NHS Values

Patients, public and staff have helped develop this expression of values that inspire passion in the NHS, and that should underpin everything it does.

Working together for patients

Patients must come first in everything the NHS does. All parts of the NHS system should act and collaborate in the interests of patients, always putting patient interest before institutional interest, even when that involves admitting mistakes.

Respect and dignity

Every individual who comes into contact with the NHS and organisations providing health services should always be treated with respect and dignity, regardless of whether they are a patient, carer or member of staff.

Commitment to quality of care

The NHS aspires to the highest standards of excellence and professionalism in the provision of high-quality care that is safe, effective and focused on patient experience.

Compassion

The business of the NHS extends beyond providing clinical care and includes alleviating pain, distress, and making people feel valued and that their concerns are important.

Improving lives

The the NHS seeks to improve the health and wellbeing of patients, communities and its staff through professionalism, innovation and excellence in care.

Everyone counts

Nobody should be discriminated or disadvantaged, and everyone should be treated with equal respect and importance.

Scientists use stem cells to create human/pig chimera embryos…

In greek mythology, a chimera was a fire-breathing female monster with a lion’s head, a goat’s body, and a serpent’s tail.

A chimera now, scientifically speaking, is made of cells that are derived from two (or sometimes more) organisms. These “parent” organisms may be of the same or different species. The defining feature of a chimera is that the individual cells in its body are genetically distinct. Instead of a mixture of genes from each parent organism, a given cell contains the genetic information of only one parent organism.


 Why create a chimera?

Potential applications for chimeric embryos have been pointed out:

  • platforms for the study of human development and disease

  • developing new models of neurodegenerative and psychiatric diseases

  • speed up the screening of therapeutic drugs.

The biggest application in my opinion is the potential of eradicating organ shortages for transplantation. Currently there are over 6,500 people on the UK national transplant waiting list and, during the last financial year, over 400 people died whilst on the waiting list. This is because, despite more than 500,000 people dying each year in the UK, fewer than 6,000 people die in circumstances where they can become a donor.

Researchers may one day overcome this problem by growing spare human organs in other animals.They are still far away from that, but this was an important first step.


Before that step though, scientists created a rat/mouse chimera by introducing rat cells into mouse embryos and letting them mature. Other researchers had already created a rat/mouse chimera in 2010. That chimera was a mouse with pancreatic tissue formed from rat cells.

Scientists Izpisua Belmonte and Wu built on that experiment by using genome editing to flexibly direct the rat cells to grow in specific developmental niches in the mouse. To accomplish this, they used CRISPR genome editing tools to delete critical genes in fertilized mouse egg cells, so they deleted the genes in mice that coded not only for the pancreas, but other organs, such as the heart and eyes, as well. The researchers then injected rat stem cells, which eventually grew into these missing organs.  The rat cells had a functional copy of the missing mouse gene, so as the organism matured, the rat cells filled in where mouse cells could not, forming the functional tissues of the organism’s heart, eye, or pancreas.

Rat cells also grew to form a gall bladder in the mouse, even though rats stopped developing this organ themselves over the 18 million years since rats and mice separated evolutionarily. This suggests that the reason a rat does not generate a gall bladder is not because it cannot, but because the potential has been hidden by a rat-specific developmental program. The microenvironment has evolved through millions of years to choose a program that defines a rat.


The group tried making rat-pig chimeras, but this didn’t work—the species were too different.

The team’s next step was to introduce humans’ cells into an organism. They decided to use pig embryos as hosts because the size of this animal’s organs more closely resembles humans than mice. The team encountered the scientific challenge of determining what kind of human stem cell could survive in a pig embryo.

The researchers injected several different forms of human stem cells into pig embryos to see which would survive best. The cells that survived longest and showed the most potential to continue to develop were “intermediate” human pluripotent stem cells. So-called “naïve” cells resemble cells from an earlier developmental origin with unrestricted developmental potential; “primed” cells have developed further, but still remain pluripotent. intermediate stem cells led to better integration.

The human cells survived and formed a human/pig chimera embryo. Embryos were implanted in sows and allowed to develop for between three and four weeks. That was long enough for them to try and understand how the human and pig cells mix together early on without raising ethical concerns about mature chimeric animals.


However, even using the most well-performing human stem cells, the level of contribution to the chimerized embryo was not high, and  many of the chimeric embryos were underdeveloped.

According to the authors, there are several reasons why the human-pig experiments did not work as well as the mouse-rat ones.

  • Pigs and humans about five times more distant evolutionarily than mice and rats

  • The rodents have much more similar gestation period – mice and rats differ by a few days, while pigs and humans are off by more than five months, so the researchers needed to introduce human cells with perfect timing to match the developmental stage of the pig. It’s as if the human cells were entering a motorway going faster than the normal motorway – if you have different speeds, you will have accidents.


Some consider this hurdle to be good news. One concern with the creation of human/animal chimeras is that the chimera will be too human. For instance, researchers don’t want human cells to contribute to the formation of the brain and reproductive systems. (In this study, the human cells did not become precursors of brain cells that can grow into the central nervous system. Rather, they were developing into muscle cells and precursors of other organs). There is this possibility, but scientists have ways in the lab to prevent this from happening, such techniques include terminating the experiment before the chimeric embryo is fully developed or born, and genetically and epigenetically directing the stem cells away from developing in those organs.


The next step, for the researchers, will be to develop strategies to improve the human cell contributions to the pig embryo before trying to combine it with CRISPR-Cas9 technology. They would like to reach about 0.1 to 1 percent of human cell contribution – now we only observe very few human cells, around one cell in 100,000 pig cells.The scientists’ other next challenge is to improve efficiency and guide the human cells into forming a particular organ in pigs.

To do this, the researchers are using CRISPR to perform genome editing on the pig genome, as they did with mice, to open gaps that human cells can fill in. The work is in progress.

The ultimate goal of producing organs for transplantation is still in the distant future. There was, however, another important step made this week. In a study published from the University of Tokyo, scientists reported having successfully transplanted a mouse pancreas generated in a rat back into a mouse. That organ remained functional for more than a year. The success of the study is a welcome sign that the strategy can actually work – so they were very happy to see those results.

How scientists are preparing for a world without antibiotics

Antibiotics have protected us for 70 years, but now they’re losing their edge. Bacteria are becoming resistant to antibiotics that used to wipe them out through mutations that occur in their DNA.

If this issue is not addressed, it will kill 10 million a year by 2050, costing the global economy $1 trillion.

Those with weakened immune systems would be particularly vulnerable, but everyone is at risk of being infected by this type of bacteria. One reason why this is such a big deal is that antibiotics may end up useless against small infections, say, from a small cut or wound.

Some ideas have been formulated by medical scientists as to how to tackle the issue.

  1. Disarm the bacteria

Bacteria don’t need to be destroyed for them to not cause harm. Attacking the weapons that make them harmful means that the bacteria will still be there, but consequences of the infection won’t be severe, giving the immune system a chance to combat the infection.

If a drug doesn’t actually kill bacteria, there is a less chance of bacteria DNA evolving so mutating to overcome the antibiotic.

2. Get rid of their toxins using nanoparticles

Many bacteria secrete toxins that damage the cells of their host, e.g. pore-forming toxins, that punch holes in cells. Nanoparticles coated with red blood cell membranes draw in toxins that would otherwise attack healthy cells, and theses can serve as a sponge to soak up all the toxins.

The downside to this method is that is very expensive, and also quite difficult to direct the nanoparticles around the body to the point of infection. Since the nanoparticles are foreign particles, they may also trigger an immune response. More research would still need to be done on how to prevent the nanoparticles from breaking down and accumulating in the body.

3. Nanoparticles for delivery

Using nanoparticles, scientists have been able to deploy thousands of concentrated hitd of drugs. This was because the nanoparticle used in this case easily stuck to bacterial membranes and allowed for the release of the drug right onto the bacteria. This then overwhelmed the bacteria’s resistance mechanisms and ensured that the antibiotics could do their job.

4. “Bacteria-hungry” viruses

Viruses that are specialized to prey on bacteria are called bacteriophages. These phages are extremely effective bacteria killers. By genetic engineering, they can restore a bacteria’s sensitivity to antibiotics. Reprogrammed phages can lock onto the gene coding for antibiotic resistance on a bacteria’s DNA and get rid of it.

For the bacteria that have mutated to form biofilm, a protective barrier that antibiotics can’t penetrate, phages can be engineered to chew up the biofilm.

However, again, there are downsides to using these phages. They can pick up the gene coding for antibiotic resistance and transfer it to another bacteria, which of course defeats the objective. As with all of the mentioned ideas, there is still a high chance of triggering an immune response.

This antibiotic-resistance crisis is global, reflecting the worldwide overuse of these drugs.

Using antibiotics on their own was and will continue to be a temporary solution to our longstanding war against bacterial infections. There are issues that come with all the potential solutions, and all of these solutions are temporary –  we know that bacteria will keep evolving whatever we throw at them, so we will always need something new.

Health to Mars…

One topic that really excites me is that of the human exploration of space. In October of last year, former US president Obama announced the US’ ambition to send people to Mars in 2030. This was, of course, a very exciting moment, however, were the Mars-bound astronauts to leave today, they would be confronting some very serious health risks.

Firstly, they would face the usual risks that any astronaut would face. A few examples are:

Kidney stones: This may happen because our bones demineralize in a weightless environment, and this releases salts such as calcium phosphate into the blood. These salts can concentrate in the kidneys, and in time may form kidney stones.

Cardiac problems: Thanks to microgravity, the heart doesn’t work as hard in space, which can cause a loss of muscle mass which could initiate arrhythmia and heart failure.

Radiation: Perhaps the risk that heeds the greatest accentuation for this situation – one mission to Mars could expose an astronaut to two-thirds of their safe lifetime limit of radiation. In terms of accumulated dose, it’s like getting a whole-body CT scan once every five or six days.

Galactic cosmic rays (GCR) are the main cause of this. These rays are made up of atomic nuclei from which all of the surrounding electrons have been stripped away during their high-speed passage through the galaxy.They come from other stars in the Milky Way and even other galaxies and exposure to them brings Mars-bound astronauts the very much increased risk of facing chronic dementia.

Hence the big question – will astronauts traveling to Mars remember much of it?

Studies have shown that test rodents’ exposure to charged particle irradiation (made up of fully ionized oxygen and titanium) – mirroring those found in galactic cosmic rays that bombard astronauts during extended space flights – caused them significant long term damage, which then resulted in cognitive impairments, as well as dementia.

Six months after exposure, the researchers still found significant levels of brain inflammation and damage to neurons. Imaging revealed that the brain’s neural network was impaired through the reduction of dendrites and spines on these neurons, which had disrupted the transmission of signals among brain cells. These deficiencies were parallel to poor performance on behavioral tasks designed to test learning and memory.

In addition, it was discovered that the radiation affected “fear extinction”, an active process in which the brain suppresses prior unpleasant and stressful associations, for example when someone who nearly drowned learns to enjoy water again.

Deficits in fear extinction makes one prone to anxiety, which could become very problematic over the course of a three-year trip to and from Mars.

This is not positive news for potential Mars-bound astronauts. The symptoms of dementia in humans include:

  • Difficulty completing familiar tasks

  • Problems communicating

  • Disorientation

  • Problems with abstract thinking

  • Loss of initiative

  • Recent memory loss

Whilst dementia-like deficits in astronauts would take months to manifest, the time required for a mission to Mars is sufficient for such impairments to develop. Looking down this list, it’s obvious that any one of these symptoms expressed in an astronaut could end up failing the mission.

Investigating how space radiation affects astronauts and learning ways to mitigate those effects are critical to further human exploration of space.

Partial solutions are being explored:

Pharmacological strategies: these would involve compounds that scavenge free radicals and protect neurotransmission.

More mass of traditional spacecraft materials: The sheer volume of material surrounding a structure would absorb the energetic particles and their associated secondary particle radiation before they could reach the astronauts. However, putting this idea into practise would be prohibitively expensive, since more mass will in turn equal more fuel required to launch the spacecraft in the first place.

Hydrogenated boron nitride nanotubes: Since protons and neutrons are similar in size, one element blocks both extremely well—hydrogen. These nanotubes are tiny, and are made of carbon, boron, and nitrogen, with hydrogen interspersed throughout the empty spaces left in between the tubes. Boron is also an excellent absorber secondary neutrons, making hydrogenated BNNT’s an ideal shielding material.

This material is really strong—even at high heat—meaning that it’s great for structure. Remarkably, researchers have successfully made yarn out of BNNTs, so it’s flexible enough to be woven into the fabric of space suits, providing astronauts with significant radiation protection even while they’re performing spacewalks in transit or out on the harsh Martian surface.

I feel like it’s impossible to predict how cutting-edge technologies used to develop manned missions to Mars and habitats on Mars will benefit other fields like medicine. However what can we do with history except learn from it?  During its first three years in space, NASA’s prized Hubble Space Telescope snapped blurry pictures because of a flaw in its engineering. The problem was fixed in 1993, but to try to make use of the blurry images during those initial years, astronomers developed a computer algorithm to better extract information from the images.

It turns out the algorithm was eventually shared with a medical doctor who applied it to the X-ray images he was taking to detect breast cancer. The algorithm did a better job at detecting early stages of breast cancer than the conventional method, which at the time was the naked eye.

From stories like this, we learn that research often leads to breakthroughs, and whether it may be in the way the researchers intended or not, research saves lives.

I’m looking forward to watching humans take their first steps on mars, but I sure do hope they’ll remember it!

Hello world!

Hi all!

“Med. on my mind” is a place where I can express my views on medicine-related topics,  try and make plain medical ideas and discoveries, and share my journey towards becoming a professional doctor with anyone who’d like to know. The blog will also contain posts regarding any work experience I’m doing and reviews of books, films etc that I come across.

I cannot explain to all of you reading how excited I feel about beginning this blog and the medical journey I am about to undertake, so stick with me, have a little scroll, and enjoy!

‘Dami