Download STIMulus February/March 2015 No. 1

STIMulus
In this Issue:
! The US Healthcare of
Tomorrow
! 3D Printing in Cardiovascular
Medicine
! Growing New Heart Valves
! Back to the Basics in the Out
of Hospital Setting
! Predicting Influenza
February/March 2015
No. 1
A Letter from the Presidents
Hello and welcome to the first edition of the bimonthly STIMulus Newsletter. STIM
(Students for Technology In Medicine) is a new student interest group dedicated to all things tech
in medicine. One of our primary goals is to educate ourselves and our peers about all the latest
and greatest happenings in the world of medical bio-tech, and come together to discuss the
incredible advances that are shaping the future of our profession.
Here, we present a distillation of a fraction of a portion of just some of the things that are
happening in science and engineering in medicine. We live in a time where technological
advances regularly transform previously impossible musings into milestones of the past, and we
should be a part of that. The more we collectively know, and are able to articulate, the more we
can work together with the interdisciplinary groups that design the future of medicine. We hope
this newsletter inspires you to learn more. We hope you join us in bringing more information to
the table. The stronger these collaborations, the better off our field and our patients will be.
STIMulus is open to anybody who would like to submit an article. We are looking for any
article on new tech, new procedures, faculty spotlights and interviews, opinion pieces on the
ethics of controversial technology applications, reviews, etc. We all have a unique background
and are capable of contributing a valuable voice to the collective discussion. We hope that you
take the time to investigate our newsletter, and let us all know what kind of exciting things are out
there. We look forward to reading your submissions.
Sincerely,
Katelyn Gurley
Vikramjeet Singh
Co-Founders of STIM
1
2
3
Visions of the
Future: The US
Healthcare of
Tomorrow
Tony Tzeng
Introduction
Walking into a present-day
hospital, a physician from the early
20th century would find himself
immersed
in
a
nearly
unrecognizable environment.
Advances in technology and
research in the sciences have
facilitated
unprecedented
progress in medicine. Within
the last century, doctors have
improved their understanding
of disease pathologies and
mechanisms,
conquering
various medical challenges
and saving countless lives.
Discoveries and inventions
like
vaccinations
and
antibiotics have transformed
healthcare in the United
States.
Despite
these
advances,
troubling
discontinuities remain in the
healthcare system: patient
dissatisfaction escalates as costs
continue to skyrocket. This cost
inflation has not correlated with
corresponding improvements in the
quality of care; in recent years, US
healthcare has fared sub-optimally
compared
to
its
international
counterparts1. As patient demand
rises from an influx of baby boomers
presenting
with
chronic
comorbidities, the increased patient
volume and complexity further
exacerbates
issues
faced
by
medicine today.
Upgrading Our Tools
Just as universal healthcare
tools, like the stethoscope, have
evolved through the decades,
current
technologies
will
also
transform.
Particular
healthcare
2
technologies that will be enhanced
include
those
involved
in
healthcare delivery, continuation
of care, and patient education and
empowerment.
Ranging
from
diagnostic modalities to electronic
health records (EHRs) to patient
educational multimedia, these
technologies will be shaped by the
pressures and challenges of the
current environment.
One major factor affecting
health outcomes is improved
diagnostic
technologies
that
facilitate earlier disease detection.
Radiographic
imaging
and
sequencing have vastly upgraded
the
diagnostic
capabilities
physicians have at their disposal.
Since their introduction, these
technologies continue to be
refined. Radiography, including
MRI and PET scans, has developed
better specificity, sensitivity, and
molecular imaging capabilities
that can be utilized in tracking
disease biomarkers. Similarly,
other diagnostic tools, such as
sequencing and assays, have
become
more
efficient,
characterizing and identifying
pathogenic organisms in an
increasingly timely manner. These
tests can
now also
detect
resistance profiles, which will play
a vital role in treatment plans,
especially
in
this
era
of
widespread antibiotic resistance.
These innovative capabilities need
to be incorporated into the
standard of care and will further
enhance healthcare delivery.
EHRs currently facilitate the
transfer of patient information
between
physicians,
ensuring
continuity of care, but complaints
from physicians include incessant
pop-up alerts and non-intuitive
systems that force them to spend
more time in front of a computer
than interacting with patients.
However, the future could see a
universal and more user-friendly
system with enough flexibility
for general practitioners and
specialists.
Such
systems
could become more adaptive
in
warning
of
potential
adverse events, minimizing
false positive alerts. EHRs
should and will enhance the
physician-patient relationship
rather than obstruct it: EHRs of
the
future
will
improve
continuity of care between all
providers
and
enhance
healthcare
delivery
integration and coordination
of care.
As
more
patients
present
with
multiple
comorbidities, the patient’s
role in medicine has evolved,
shifting
from
medical
paternalism to active patient
participation. Beyond receiving
health information solely in the
physician’s office, patients now
have access to such information
with a single click; furthermore,
multimedia has been harnessed to
enable and encourage the patient
to stay informed about their own
health. Currently, smart phone
apps can not only provide
scientifically valid information and
reminders for daily medications but
“...#technologies#will#be#
shaped#by#the#
pressures#and#
challenges#of#the#
current#environment."#
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can, with input devices, measure glucose levels or
record electrocardiograms, alerting the patient of
impending medical crises. In the future, these
applications can be improved, validated, and expanded
to measure a plethora of critical health markers.
Ubiquitous smart devices will become key tools for
empowered healthcare, especially for patients at high
risk of adverse events. Actively engaged patients will
work together with physicians, enhancing healthcare
delivery, decreasing overall health costs, and most
importantly, optimizing patient satisfaction.
Glimpses into the Future
Many new ideas and innovations, while currently
in their infancy, could revolutionize physicians’ abilities
to deliver patient care. Advances in nanotechnology will
yield therapeutics of unprecedented precision, with
nanoparticles capable of delivering payloads ranging
from anti-cancer drugs to small molecule RNA2. Stem cell
research could transform the lives of patients affected by
currently untreatable conditions: curing hearing loss or
reversing neuro-degeneration
through regulated
cellular regeneration is potentially within reach3,4. Gene
therapy, temporally and spatially controlled through
radio waves, magnetic fields, or light, may allow precise
modification of gene expression with outcomes such as
the activation of insulin expression in diabetics or the
restoration of sight compromised by retinal diseases5,6.
Finally, the proverbial Damocles’ sword, antibiotics
resistance, seemed posed to apocalyptically reverse the
major gains of the 20th and 21st centuries. But with the
first significant antibiotic discovery in decades,
teixobactin, and the development of a novel method of
cultivating and utilizing the vast arsenal of
microorganisms incapable of growing in a petri dish,
the fight against antibiotic resistance no longer
appears as bleak7. This cutting edge technique could
provide a wealth of possibilities, not just for new
antibiotics but also for new therapeutics against other
diseases like cancer. Finally, progress has been made
in alleviating the debilitating effects of mental
disorders, which bear the further burden of societal
stigma. A greater understanding and acceptance of
mental health in the future will lead to other
therapeutics that avoid the pitfalls of current ones, such
as significant side effects and varying effectiveness
depending on dosage and individual8,9,10.
Conclusion
The keys for the future lie in better organized
and coordinated medical care, continued research of
disease processes and treatments, and increased focus
on patient education and involvement. Advances in
novel technologies and treatments are promising, with
great potential on numerous fronts against varying
diseases. However, as the internet and other sources
continue to bombard patients with information, it is
crucial for physicians to provide accurate information
through the use of these same media and to challenge
false assertions made by well-intentioned but
misguided sources. Although medicine faces several
challenges, the progress of medical development is
and will continue to be miraculous: no doubt the
present-day physician will be astounded should he or
she wander through the hospital wards of the next
century.
5 Apple Apps that Patients Could Be Using Right Now:
1) GlucoSuccess (by the Massachusetts General Hospital) – Keeps
track of glucose levels by syncing to the glucometer
2) Asthma Health (by Mount Sinai) – Monitors local air quality and
reminds patients of their medications
3) Parkinson mPower Study app – Monitors Parkinson symptoms
(speech, gait, finger tapping, and memory) over time using iPhone
sensors
4) Share the Journey – Another symptom tracker for patients after
breast cancer treatment
5) MyHeart Counts (by Stanford University) – Tracks fitness and
educates patients on their own heart conditions
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3D Printing in
Cardiovascular
Medicine
$MJDLPO
JNBHFGPS
NPSFJOGP
BOEBWJEFP
Aaron Lin
The birth of the earliest
prototypes of 3D printers was in
the late 1980s, but it has been
gaining popularity recently,
especially in the healthcare
field. 3D printing works similarly
to an inkjet printer: a head or
needle moves back and forth in
a predetermined pattern and
squirts material along the way.
In the case of an inkjet printer,
it’s ink. In the case of a 3D
printer, it’s plastic, silicone, or
even cellular material. With the
growing availability of 3D
printing, doctors are finding
ways that it can help their
practice. For instance in the
cardiovascular surgery field,
there have been doctors from
New York, Kentucky, and Florida
who have created 3D printed
replicas of their patient’s hearts
to help plan for a complicated
surgery.
Conventionally,
doctors would open the chest,
stop the heart, look inside, and
figure out what to do. By utilizing
modern
technology,
these
doctors decided to use 2D slices
from either CT or MRI scans to
create a computerized 3D model
and print out a model of the
diseased hearts. From here, they
were able to manipulate vessels,
peer into chambers, and create
plans to redirect blood flow or
remove
obstructions.
Even
more, their patients have had
accelerated
post-surgery
recovery times when compared
to patients who have been
treated
using
conventional
4
methods.
3D
printing
is
also
benefiting surgeons-in-training. At
Nottingham Trent University in
London, a man named Richard Arm
claims that he has a model of a
human heart that is “as close as you
can get without creating artificial
muscle fibres.” He uses CT scans to
determine the densities of the
different parts of the heart and then
uses a blend of different silicone
gels to print a squishy, true-to-color
human heart. He claims that it is so
realistic a surgeon trainee could cut
into it and it would be not unlike
cutting into a real heart. By utilizing
3D printing instead of working on
basic plastic models, students will
have a chance to experience the
sensation of cutting into a heart and
practice without repercussions. The
university also plans on pumping
artificial blood through the heart to
produce an even more realistic
simulation.
“…it%would%not%be%
unlike%cutting%into%a%
real%heart.”%
Perhaps the most attractive
possibility of 3D printing is that of
creating human organs. Scientists
have already succeeded in creating
a phenotypically functioning liver
(although it was 500 microns thick
and lived only five days). Some
experts suggest that a 3D printed
heart is not far off: perhaps within
ten years! This could solve
numerous problems. Some patients
may not be candidates to receive
from an organ donor, and, of course,
some may not find a suitable match
in time. If constructed from the
patient’s own cells, rejection and
anti-rejection drugs wouldn’t be an
issue.
Stuart K Williams, executive
and scientific director at the
Cardiovascular Innovation Institute
at the University of Louisville, has
some lofty goals. His vision is for the
patient to enter the operating room,
have some fat tissue removed,
isolate stem cells, mix those cells
with extracellular matrix materials,
and print the heart within hours.
However, today’s 3D printing
timescales are more along the lines
of an overnight process and are still
being refined.
As with any endeavor in new
realms of medicine, these types of
advances in biotechnology require
inter-professional
alliances.
Engineers need to collaborate with
physiologists
to
create
a
mechanically
and
electrophysiologically functioning
heart, and engineers need clinicians
to access patients who need these
technologies. Do you think you have
what it takes to venture to the
forefront of medical technology?
LSUHSC School of Medicine’s
Learning Center has their very own
3D printer: a Makerbot Replicator
Z18. Consider working with the
Learning Center on ideas or
projects that could potentially help
future patients!
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Growing New Heart Valves: A
Tissue Engineering Approach
Katelyn Gurley
Valvular heart disease can lead to very
serious complications and is a leading cause of
morbidity and mortality in aging populations. An
estimated
67,500
surgical
aortic
valve
replacements are performed annually in the
United States1, and with an aging population, the
demand for such surgical intervention will only
increase.
Mechanical prosthetics can be used to
replace failing valves, but they can also lead to
complications resulting from clotting and
scarring. Additionally, as these prosthetics are
non-living, they are unable to perform dynamic
remodeling in response to mechanical stress,
and can wear out over time2.
A common
approach is to replace a failing valve with one
from an animal heart of similar size (usually
porcine or bovine), a procedure known as a
xenograft.
However, biologic valves are
susceptible to fibrosis and calcification, and can
lead to immunogenic rejection of the graft
causing heart failure3.
In the past several years, biomedical
engineers have worked towards a more elegant
approach, in which a patient’s own cells are used
to grow a living replacement heart valve. The
approach uses biological scaffolds, a threedimensional fiber skeleton suspended in a
hydrogel upon which autologous stem cells can
proliferate and develop4. The scaffold, made of
synthetic
polymer
or
de-cellularized
animal/donor tissue, mimics the extracellular
material of a native valve (a mixture of collagen,
elastin, and glycosaminoglycans), providing the
tissue with its structural support. Scaffolds are
then permeated with developing autologous
cells, which can be found in the endothelial cells
of peripheral arteries, or in bone marrow derived
stem cells5.
The structure is placed in a
biomimetic environment, and the scaffold
provides support until sufficient new tissue forms,
as the scaffold eventually degrades.
5
This approach to growing allograft
transplants addresses many of the problems
associated with mechanical or biological
valves, particularly in mitigating the immune
response to foreign tissue. Furthermore, the
scaffold approach provides a living tissue that
exhibits remodeling, regeneration, and
growth potential6, and also reduces blood
damage from mechanical trauma as it is
grown specifically to operate within a
physiological system.
Living tissue engineered heart valves
have shown success implanted in animal
models, with adequate functionality for an
extended time7. The technique shows great
promise for the future of cardiovascular
repair; however, there is more to learn about
the exact biochemical processes which
facilitate neotissue remodeling. With greater
understanding, a more intelligent design can
be implemented, perhaps incorporating
specific signaling molecules into the scaffold
to obtain a safe, durable, and precisely
designed end product. As the technique is
refined, the possibility for more complex
organ synthesis could become a real
possibility, giving hope to those waiting for
new parts.
FUN FACT: Arne Larsson was the
first patient to receive an
implantable pacemaker and
outlived the inventor and the
surgeon.
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Cardiac Arrest: Back to the Basics in the
Out of Hospital Setting
Tony Tzeng
At the front lines of medical care, every minute is crucial,
and every decision could mean the difference between
life and death. Emergency medical service (EMS)
personnel operating in non-hospital environments must
stabilize and transport the patient rapidly, often in
suboptimal conditions. These personnel, including
paramedics, are often trained not only in basic life
support
(BLS),
which
includes
ventilation,
cardiopulmonary resuscitation, and AED defibrillation,
but also in more complex advanced life support (ALS)
procedures such as advanced airway and intubation
techniques1,2. However, current findings question the
effectiveness of ALS compared to BLS procedures with
recent studies suggesting a lack of significantly superior
outcomes from ALS in the majority of trauma and nontraumatic situations 3-9.
Cardiac arrest, particularly in the out of hospital setting,
remains a significant problem in the United States as well
as internationally despite improvements in survival
rates15-17. In fact, statistics from
the American Heart Association
(AHA) suggests that 359,000
cases of out of hospital cardiac
arrest occur annually in the
United
States18.
However,
studies suggest a lack of
evidenced-based support for
improved outcomes from ALS
compared to BLS treatment in
cardiac arrest patients in the
non-hospital,
non-traumatic
setting4,10-14. This article will
review the current literature
concerning ALS versus BLS
techniques in out of hospital
cardiac arrests.
assumption that these techniques lead to improvements
in patient care12. Endotracheal intubation and
supraglottic airway devices are the most common
advanced airway techniques utilized by paramedics19 .
Studies, including a notable study by Hasegawa et al,
suggest that, in comparison to bag mask ventilation,
intubation results in poorer outcomes and survival to
discharge in out-of-hospital cardiac arrest20-22. A recent
systematic review incorporating 17 observational studies
has also found worse outcomes from supraglottic airways
compared to intubations. Overall in the study, there
were superior outcomes from basic airway interventions
over advanced airway techniques, including both
intubation and supraglottic airways 22-24.
Several possibilities may explain this discrepancy in ALS
and BLS care in out-of-hospital cardiac arrest patients.
Causes of this decline in patient outcomes from
advanced airway techniques may be attributed to the
risks of unrecognized intubation of the esophagus,
exacerbation of original injuries,
and
hindrance
of
chest
compressions
as
well
as
insufficient
training
and
practice22, 25.
As noted in
previous studies, significant
experience with intubation is
necessary
for
successful
placement—over
100
intubations are needed for a
95% success rate in the ideal
surgical hospital environment—
so it is not wholly unexpected
that emergency personnel, in
suboptimal conditions with a
much lower proficiency and
practice rate have substandard patient outcomes with
this technique25-28.
“359,000%cases%of%
out%of%hospital%
cardiac%arrest%occur%
annually%in%the%
United%States.”%%
In the first study comparing ALS and BLS utilizing a
United States population, Sanghavi et al found that BLS
had an overall lower charge per survivors to one year,
and BLS treated patients had better outcomes10. Patients
had higher rates of surviving to hospital discharge and
90 days and improved neurological functionality10. These
results are similar to results from international studies by
Ma et al and Stiell et al, suggesting that BLS is superior in
care and transport of out-of-hospital cardiac arrest11,12.
The benefits of ALS are advanced airway techniques and
IV drug delivery yet scant evidence supports the
6
The second benefit of utilizing ALS is IV drug delivery.
However, IV drug administration of agents like
epinephrine did not have a profound effect on long term
outcomes after a year though some studies did find
immediate short term effects on survival leading to and
up to one month following discharge12,29-33. Further
complicating analysis of the effects of IV drug
administration is the widespread variation in drug
administration by EMS personnel in the United States,
which may contribute to the lack of effectiveness of ALS
interventions34.
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Lastly, time also may be a crucial factor causing the
differing outcomes in ALS and BLS techniques, with
Sanghavi et al reporting longer times on scene by ALS
personnel which may delay transport to the hospital and
have adverse effects on outcomes10.
However, it would remiss not to consider confounding
factors and weaknesses in the literature. Crucially, the
majority of these studies were observational studies,
especially since a randomized control trial may be
challenging to conduct in these circumstances. (Con’t)
Therefore, the result is that the effects of biases and
confounding factors are much greater. Perhaps the most
difficult to account in this situation would be the bias of
indication: a patient who is indicated for an out of
hospital intubation may have worse outcomes regardless
of which techniques were utilized. Additionally,
procedures in EMS systems may vary greatly
geographically in the United States such as regarding
drug administration, let alone internationally, suggesting
that studies from abroad may be less applicable to the
situation in the US. Finally, most if not all of these studies
were conducted in an urban environment, and their
results and conclusions may not necessarily be as
relevant in a rural environment since transport time as
well as access to medical care and resources may be
different than in a city.
In conclusion, ALS procedures either need to be
improved or de-emphasized in favor of the BLS
techniques in out of hospital cardiac arrest patients.
Health policy and procedures need to reflect the
literature in order to best optimize the care given to
these patients, a population who already has a high
mortality rate. Overall, this review demonstrates the
importance and need for relying on evidence-based
medicine in patient care.
TIGER TECH
Corner
Did you know that there is a FREE online
3D program for anatomy? Check this out:
https://www.biodigital.com/education.
Sign up today!
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What if you could predict a major outbreak before it
happened? Imagine building vaccines for pathogens
that have years of evolution left before they are able to
cause disease. As technology continues to develop at
an exponential pace, such possibilities have already
been introduced to the realm of reality. Instead of mere
speculation, researchers today are able to predict the
evolution of asexual organisms such as viruses or
cancer cells with an algorithm-based approach to
evolution developed by researchers at the Max Planck
Institute for Developmental Biology in Tübingen in
Germany. This algorithm was first tested in the
development of a vaccine for the A/H3N2 influenza
virus for the 2015 flu season.
The thinking behind this algorithm references the
branches of the genealogical trees of an organism to
infer the capability of the organism to survive. The
driving idea is that the fitter lineages have more
offspring. Thus, the genealogical trees of these lineages
will have more branches. Previously, fitness models
have been developed using surface proteins, as well as
amino acid sequences, to predict seasonal influenza
viruses; however, such fitness models are extremely
difficult to develop for most organisms. The beauty of
using this new general algorithmic approach is that it
relies on no molecular data pertaining to viruses
whatsoever. Instead, the algorithm infers fitness from
the shape of the genealogical trees derived from
historical data. Since many offspring implies high
fitness, the shape of the genealogical tree is used as a
marker for high fitness. The algorithm requires a
genealogical tree as input; a tree can be reconstructed
from a sample of genomic sequences. The algorithm
then traces fitness along lineages and integrates across
the tree to deliver a quantitative result. Hence, the
RESEARCH SPOTLIGHT
Predicting Influenza
Evolution through
Algorithms
Vikramjeet Singh
method builds upon our increasing understanding of
the statistical structure of genealogies in adapting
populations to construct a quantitative model of fitness
dynamics.
There are two key assumptions the
researchers used in developing this method. The first
is that the populations are constantly undergoing
directional selection. Second, small effect mutations
accumulate throughout lineages to affect overall
fitness dynamics.
For validation and reliability purposes, the
researchers tested this algorithm-based method on
both simulated data and historical data on seasonal
A/H3N2 virus sequences occurring in North America
and Asia from 1995 to 2013. For testing purposes, the
researchers used genetic data of viral surface proteins
from one year to reconstruct a genealogical tree. This
tree was then used as input in the algorithm to predict
the dominant viral strain type for the upcoming year.
The results showed that for the majority of the 19 years
analyzed, the method gave informative predictions
regarding the viral type that would be prevalent in the
upcoming year. When compared with a model
designed specifically for influenza using genetic data,
the genealogical tree based algorithm made
predictions of similar reliability while retaining the
capability of being applied to many different
organisms not just influenza.
This methodology makes a lot of sense in the world of
quantitative data analysis. It is proof of concept that
simple algorithms such as the one described can be
used to make precise assessments of future outcomes
that can be applied to different organisms without the
need to develop complex models based on explicit
data. From a statistical standpoint, correcting for
predicted vs attained changes and integrating data
from a number of years can lead to the development
of more precise algorithms that are essential for
developing technology based approaches to
healthcare and medicine.
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WE LOVE FEEDBACK! Should we add medical technology
puns? How about funny pictures? What other topics should we include?
Let us know how we’re doing! We are completely open to suggestions
and ideas. Most importantly, we want to know what YOU, our readers,
think!
Have a professor you really want to interview? Read an article you
think will benefit your peers? Have an opinion on technology you want
heard? Email us with your article today!
Our next deadline for the April/May edition is April 24th
Editor
Editor
Theresa Cao
School of Medicine | Class of 2018
[email protected]
Rose DePaula
School of Medicine | Class of 2018
[email protected]
Students for Technology In Medicine (STIM) is a student-run organization of the
LSU Health Sciences School of Medicine with a focus on providing educational and
networking opportunities for students who are interested in the field of
biotechnology as it relates to the field of medicine. We hope to raise community
awareness of the local, regional, and global technological advancements and
bioinnovations that will be crucial in future patient healthcare.
Follow us on Twitter (@lsustim) for the latest news and information.
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References
Visions of the Future: the US Healthcare of Tomorrow
1. http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
2. http://www.ncbi.nlm.nih.gov/pubmed/25585320
3. http://www.ncbi.nlm.nih.gov/pubmed/24812404
4. http://www.ncbi.nlm.nih.gov/pubmed/24252976
5. http://www.ncbi.nlm.nih.gov/pubmed/25569545
6. http://www.ncbi.nlm.nih.gov/pubmed/25759964
7. http://www.ncbi.nlm.nih.gov/pubmed/25561178
8. http://www.ncbi.nlm.nih.gov/pubmed/25383616
9. http://www.ncbi.nlm.nih.gov/pubmed/25664846
10. http://www.ncbi.nlm.nih.gov/pubmed/24740528
5 Apple Apps that Patients Could Be Using Right Now
1.
http://www.imedicalapps.com/2015/03/5-apple-medical-research-apps/
3D Printing in Cardiovascular Medicine
1.
http://computer.howstuffworks.com/3-d-printing1.htm/printable
2.
http://www.nhlbi.nih.gov/health/health-topics/topics/ht/after
3.
http://www.wired.co.uk/news/archive/2013-11/21/3d-printed-whole-heart
4.
http://www.foxnews.com/tech/2014/04/10/scientists-trying-to-create-human-heart-with3d-printer/
5.
http://www.bbc.com/news/uk-england-nottinghamshire-29047165
6.
http://www.independent.co.uk/life-style/gadgets-and-tech/news/3d-printed-heart-savesbabys-life-as-medical-technology-leaps-ahead-9776931.html
7.
http://www.wired.co.uk/news/archive/2014-10/02/3d-printed-heart
8.
http://www.miamiherald.com/living/health-fitness/article6521568.html
9.
http://www.wired.co.uk/news/archive/2013-04/24/3d-printed-liver
Growing New Heart Valves: A Tissue Engineering Approach
1.
2.
3.
4.
5.
6.
7.
Fun Fact
1.
Clark M.A., Duhay F.G., Thompson A.K., Clinical and economic outcomes after
surgical aortic valve replacement in Medicare patients. Risk Manag Healthc Policy.
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