Archive for: February, 2011

Not Again!

Feb 28 2011 Published by under Life of a Physician

This morning a local newcast reviewed another survey on inappropriate cell phone use. Once again, respondents took to task those of us who make calls from public bathrooms.

Seriously, it offends you if I make a call in the restroom?

As a physician on call, I frequently must use my phone in public places. They encourage us to answer as soon as we can, but call-backs within 15 minutes are generally acceptable. Now, if I am strolling through the grocery store, I can whip out the BlackBerry anywhere. It doesn't bother me at all to discuss your child's diarrhea in the meat aisle, but I cannot speak for those around me.

Famous stall in the Minneapolis Airport (click for source)

Frequently, the only reasonably private place in a public venue is the bathroom. Yes, a few women may be in there, but far fewer than are out and about in a store or a theater. When we had season hockey tickets for the UNO Mavericks, the only place I could hear a phone conversation was in the stall farthest from the door in the Qwest Center. Yes, I took calls in the toilet stall because I'm a dedicated physician who loves hockey.

If any of my readers have better ideas, let me know. Waiting to get to my car is not always practical or possible, and I felt the restroom was the best alternative.  Until they invent the portable cone of silence, I'm sticking with the Lady's Room.

Medical conversations cannot be the worst thing to happen in most public potty areas (click the photo if you don't believe me).

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Mind-Blowing Fashion

Feb 25 2011 Published by under Fashion (or not)


WTF? Click for source.

Fashion shows tend to be inspirational and artistic, rather than showing stuff that women might wear to an office or any other real-life venue. Whatever muse tempted the designer can be seen in the runway show, and it does not have to make sense.

London Fashion Week is no exception, but the press has no difficulty declaring the ultimate WTF moment thus far: the PVC Penis Beret from New Power Studio.

Racked, a fashion news site, described it as mindblowing.

Now I know a bunch of folks who sport unusual head gear on occasion (squid cap, anyone?). I'm wondering if anyone would top off their look with this hat?

Hmmm... Maybe they would donate one for a door prize at Science Online 2012.

I think I will pass on this look, though. I really don't want to be a dick-head.

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First PubMed Entry

Feb 25 2011 Published by under Wackaloonacy

Nature 1(1):1, 0000
God

Abstract
Background: in the beginning, there was nothing.
Hypothesis: A universe would be a good thing.
Methods: Earth, sky, ocean, and life were created using proprietary divine methods over a period of 6 days.
Results: I saw that it was good.
Discussion: Divine powers can be used to create, and that is good. Further longitudinal study is necessary to evaluate evolution of creation over time, and the use of divine powers for destructive purposes has not been ruled out.

PMID: 1

- Posted using BlogPress from my iPad

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I Am Still Alive

Feb 24 2011 Published by under [Medicine&Pharma]

But I would kill for a nap. The week covering inpatients drags on, and I have not gotten more than 5 hours of uninterrupted sleep. I feel very Disney, and not in a princess way.


What has kept me up on the phone? Clots.

The bane of a nephrologist's existence is access for dialysis. If we can't get blood flow, we can't do much. We usually use a drug called heparin to prevent clots from forming in our plastic tubing, but some patients develop a reaction to it called heparin-induced thrombocytopenia (HIT for short).

We switched to something called regional citrate anticoagulation. To understand this protocol, you need to know how blood clots. Cell fragments called platelets circulate in the blood, looking for damaged vessels. When they sense damage, they clump on the spot, releasing chemicals that initiate the thrombin cascade (more about clotting Here). These clotting factors require calcium to work, so removing calcium from blood will keep it flowing. Of course, a certain amount of calcium must be in the blood for normal function of heart, nerves, and other important organs. If we try to remove calcium in the circulation, the body works to remove it from the bones and fix the problem.

We use a drug called citrate to bind calcium. Citrate enters the dialysis circuit where we pull the blood out of the patient. At the same time we put calcium back into the central circulation. Calcium levels are then measured every few hous in the dialysis circuit (where we want it barely detectable) and from the patient (where we want normal blood values). The IV drips of citrate and calcium must be adjusted based on the lab measurements, especially during the first day.

So what happens if citrate gets into the patient? The liver metabolizes it into bicarbonate, which can then become carbon dioxide and water.

We have not used this anticoagulation protocol much, but it is the first line treatment at many other places. As we use it more, it will get easier and require fewer calls.

In the meantime, I'm looking forward to a night of shut-eye.

- Posted using BlogPress from my iPad

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Facts and Faith

Feb 18 2011 Published by under [Science in Society]

Click for IMDB entry

I believe... I believe... It's silly, but I believe.  Susan, Miracle on 34th Street

Faith is believing when common sense tells you not to. Doris, Miracle on 34th Street

Science means accepting what the evidence shows. Pascale H. Lane, Real Life

Miracle on 34th Street, a Christmas classic movie, revolves around the identity of a nice man with a beard who calls himself Kris Kringle. Could he be the real Santa Claus, as he says he is?

His lawyer "proves" to the state of New York that he is because the US Postal Service delivers Santa letters to him in a series of random events. Hmmm, the postal service mis-delivers mail for other people to me about once a month; does that mean I'm them?

The characters quoted above include a cynical mother (Doris) raising her daughter without fantasies such as Disney princesses and the d00ds who rescue them (yeah, she's divorced, that harlot). The daughter, played by an enchanting, pint-sized Natalie Wood, sets a task for Kris Kringle that seems impossible but that happens, with or without the help of  Santa (depends on what you believe). By the end of the flick, daughter Susan believes in Santa, Doris is back in the arms of a man, and the world believes in miracles...maybe.

Fun escapism, but the "proof of Santa" offered would not hold water in court today. No DNA evidence? No birth certificate (I mean, people in the US seem to have a difficult time accepting such legal documents as evidence when they are produced; imagine the absence of one)? Not even a quick sleigh ride to the North Pole or testimony from a helpful elf? As they said in the movie, "Clang! Clang! Bellvue!"

A bill introduced in my soon-to-be home state of Oklahoma led to a bit of a discussion in my home. Here's the scoop:

OK House of Representatives, HB 1551, authored by long-time antievolution legislator Sally Kern. I ask you to email the OK legislators on the House Common Education Committee before next Tuesday (22 Feb) to let them know you oppose this bill.

Kern’s latest bill, the “Scientific Education and Academic Freedom Act,” is an antievolution bill in the mold of the law passed in Louisiana in 2008. Under the guise of “academic freedom,” this bill would carve out a legal space for creationist teachers to bring non-scientific criticisms of evolution into the classroom. The full text of the bill can be found at the end of this email and at http://webserver1.lsb.state.ok.us/2011-12bills/HB/HB1551_int.rtf

In short, here’s why HB 1551 is a bad bill:

--Manufactured controversy. The alleged “controversies” described by this bill do not exist; scientists do not debate the validity of evolution.

--Harmful to education. This will create classroom confusion for teachers, because under this bill students cannot be marked down for certain types of answers on tests.

--Unneeded. Teachers are already free to discuss real science in science classrooms.
In more detail, here’s what’s wrong with HB 1551:

1.      “… the teaching of some scientific subjects, such as biological evolution, the chemical origins of life, global warming, and human cloning, can cause controversy.”

Evolution is not a scientifically controversial topic. Although this bill calls for teachers to promote “the scientific strengths and scientific weaknesses of existing scientific theories,” these alleged weaknesses do not come from scientists; they are creationist fabrications. The only “controversy” here is manufactured by antievolution forces. And it is worth emphasizing that part of the language of this bill comes from a Seattle-based organization with a history of promoting “intelligent design” creationism (see 6 below).

2.      One provision of HB 1551 reads: “…no student in any public school or institution shall be penalized in any way because the student may subscribe to a particular position on scientific theories.”

If this were applied literally, this means that if students answered biology test questions with, “Evolution is evil--that’s my position on your stupid theory,” such students could not be marked wrong. This would create chaos in the classroom, with teachers juggling respect for religious views with grading inaccurate answers. Religion does not belong in the science classroom, and this provision drops religious “position[s] on scientific theories” right into teachers’ laps.

3.       “The provisions of the Scientific Education and Academic Freedom Act shall only protect the teaching of scientific information, and shall not be construed to promote any religious or nonreligious doctrine.”

This assertion is flatly contradicted by decades of religiously-based attacks on evolution. It’s clear that the effect of the bill would be to encourage creationist teachers to present unscientifically warranted criticisms of evolution, and that’s enough to make it unconstitutional. Simply saying that a bill does not promote religion does not make it so.

4.       “The intent of the provisions of the act is to create an environment in which both the teacher and students can openly and objectively discuss the facts and observations of science, and the assumptions that underlie their interpretation.”

The “assumptions” language invites creationist teachers to attack well-established science; a creationist teacher might use this provision to say (falsely) that an assumption of evolution is “atheistic materialism.” In this manner, creationist teachers could disparage evolution while maintaining that they were simply following the law.

5.      HB 1551 is virtually identical, word-for-word, to a bill introduced in 2009, SB 320 (Brogdon). Discussions of SB 320 suggest it was religiously motivated; Sen. Randy Brogdon described his bill as a way to “combat the secular humanistic indoctrination,” such as 2009’s “yearlong one-sided celebration of Darwinism [at] OU.” SB 320 also proposed to solve a non-existent problem; a school superintendent in Brogdon’s district said, “I don’t think our teachers are confused at all, and I’m somewhat puzzled because Sen. Brogdon and I have never had any dialogue on the subject.”

Information from National Center for Science Education

I went home absolutely appalled that teachers would be allowed to spout creationist viewpoints in the classrooms, and that students could potentially answer questions on tests with "God made it that way" and not be penalized. My husband thought the intent of the bill was to allow teachers to acknowledge creation myths and lead a discussion that would allow the students to "see the light" of evolution, to understand the difference between fact and religion.

My husband is naive; he still believes that rational though wins the day.

Scientific inquiry involves things that can be measured and demonstrated. While subatomic particle physics includes a certain element of faith in my mind, science ultimately relies on evidence. Evidence supports evolution. Period. And global warming, and the safety and efficacy of vaccines, and the lack of harm from abortions. These scientific observations do not require belief in any particular being or myth or miracle.

Why must we keep fighting this battle? Makes me wish Santa were around to make everything rational and right with the world. Now that would be a miracle!

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Growing Kidneys

Feb 16 2011 Published by under Nephrogenesis

H/T to @sciliz for the topic suggestion.

Normal Kidney Development

Pronephros and Mesonephros (Click for Source)

The first structure to develop in any vertebrate embryo, the pronephros, consists of a single filtering unit and tubule. In some species these structures do not attach to each other; a funnel-shaped structure with finger-like projections "waves" fluid from the site of filtration into the tubule. In some species the pronephros becomes the adult kidney, but in humans and "higher" vertebrates, the pronephros exists only briefly. It induces development of another structure, the mesonephros.

This mesonephros forms multiple filtration units and tubules capable of urinary function, albeit briefly in humans. These ducts become incorporated into the genitourinary system as a more complex metanephric kidney forms. In some animals, such as the zebrafish, the mesonephric kidney is the adult kidney.

Why Zebrafish?

Since the zebrafish kidney finishes at the mesonephric stage, it cannot be a perfect model for studying human kidneys; however, it offers many advantages over other models.

For example, the zebrafish embryo is transparent, making it easy to look at things without killing or cutting up the fry:

Zebrafish Embryonic Development (Link to YouTube Video)

Zebrafish breed rapidly and continuously with a generation time of 3 months.

Sequencing of the zebrafish genome facilitates creation of fish labelled with a variety of fluorescent markers, so specific structures can be studied in situ in live critters. Zhou et al labelled glomerular cells with a red marker and tubular structures with green fluorescent protein to make photos of normal nephrogenesis:

Mesonephrogenesis in cdh17::GFP/pod::mCherry double-transgenic zebrafish. A: schematic graph illustrating the transgene structures of pod::mCherry and cdh17::GFP. Tol2-L and Tol2-R are Tol2 transposon elements to facillite the transgenesis. B: lateral view of a 9 days postfertilization (dpf) larva. Podocytes in pronephric glomeruli (arrow) are marked with mCherry fluorescence (red) and pronephric tubules and ducts are labeled with GFP fluorescence (green). cdh17::GFP expression is also present in the intestinal epithelia, where the endogenous cdh17 is expressed (12). C: lateral view of a 14 dpf larva that developed the first pair of mesonephric glomeruli (arrowheads) with matured podocytes-expressing mCherry (red). D: ventral view of a 28 dpf juvenile. Multiple glomeruli (red) are visible at the anterior and medial portions of the mesonephric kidney with convoluted mesonephric tubules. E: ventral view of a 36 dpf juvenile. More mesonephric glomeruli and more convolutions of tubules developed in the anterior and medial regions. A few nephrons are present in between the rostral and medial regions as well as in the posterior region. F: ventral view of the whole mesonephric kidney in a 6-mo-old adult. ANDR, anterior nephron-dense region; MNSR, medial nephron-sparse region; MNDR, medial nephron-dense region; PNSR, posterior nephron-sparse region. Note symmetric groups of nephrons (arrowheads) in PNSR are segmentally distributed. Anterior to the left in all the panels.

Some background nephrogenesis can occur throughout the life of the zebrafish, but it slows down after 6 months of age. They then created a fish with the green marker linked to the zebrafish homolog of Wilm's Tumor 1, a marker of renal progenitor cells. Once again, podocin, a marker of mature glomeruli, drove the red marker. They then treated the fish with gentamicin, a nephrotoxic antibiotic, and showed that after kidney damage the zebrafish grew new nephrons:

Gentamicin-induced renal injury triggers de novo regeneration of mesonephric nephrons. A, A': injection of PBS does not increase mesonephrogenesis at 5 days postinjection (dpi). The green puncta are wt1b::GFP-expressing cells at the neck of matured nephrons. B, B': by 5 dpi of gentamicin, there is an increased number of developing nephrons. C, C': at 9 dpi of gentamicin, wt1b::GFP expression indicates the progression of these newly made nephrons. D, D': level of nephrogenesis is still elevated at 14 dpi of gentamicin. E: quantification of wt1b-GFP+ nephron numbers postgentamicin-induced renal injury. *P < 0.05, **P < 0.01.

So zebrafish can grow new nephrons with genetic markers similar to those of humans in response to kidney damage. Why can't people? And can we learn how zebrafish achieve this feat and make it happen with human cells? Can these nephrogenic cells be used to grow new nephrons in different zebrafish?Using a similar fluorescent tagging technique,  Diep et al transplanted progenitor cells from a zebrafish bearing one label to other fish with different labels and demonstrated that these cells would form new kidneys in the recipient fish. These cells worked with progenitor cells in the recipient fish to form the new units:

a, Overview of the transplantation assay. b, A primary transplanted fish at 18 d.p.t. with cdh17:EGFP+ donor-derived nephrons (arrow; inset, higher magnification view; scale bar, 0.5 mm). c, Average number of donor-derived nephrons over time (error bar, one standard deviation; n, total fish per time point). d, Head kidney of a recipient at 34 d.p.t. showing expansion of renal tissue caused by cdh17:mCherry+ donor-derived nephrons (arrow; scale bar, 0.5 mm). e, A cdh17:mCherry+ donor-derived nephron showing functional uptake of 40 kDa FITC-conjugated dextran (scale bar, 30 μm). f, Connection of donor-derived nephrons (cdh17:mCherry+) with the cdh17:EGFP+ recipient’s renal system (scale bar, 10 μm). g, A mosaic nephron arising from the co-injection of a mixture of cdh17:EGFP- and cdh17:mCherry-labelled nephron progenitors. h, Overview of the serial transplantation assay. i–k, Donor-derived nephrons (cdh17:EGFP+, arrows) in primary-, secondary- and tertiary-engrafted recipients (scale bar, 0.5 mm).

The Take-Home Message

First, even if you do not love kidneys and urine as much as I do, you must admit that these studies employ cool technology and generate amazing photos. Both of these articles include supplementary photos and videos as well; you should click on over to the web sites and play!

More important, Diep et al show that progenitor cells can be transplanted. Some dormant cells may remain in metanephric kidneys (like we humans have) that we can eventually learn to stimulate to regeneration. Someday we may be able to produce progenitor cells in vitro using stem cells, and then inject them into failing kidneys.

Finally, even with their differences, zebrafish can teach us important things about the development of organs, as well as being cute and hardy pets for our tanks.

Articles:

Zhou et al: Characterization of mesonephric development and regeneration using transgenic zebrafish. Am J Physiol Renal Physiol 299:F1040-F1047, 2010.  doi:10.1152/ajprenal.00394.2010

Diep et al: Identification of adult nephron progenitors capable of kidney regeneration in zebrafish. Nature 470:95-101, 2011.  doi:10.1038/nature09669

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One of THOSE Days

Feb 15 2011 Published by under Medical Paperwork

I have begun my battle with paperwork necessary to change positions and move to a new state. Oklahoma MD licensing requires nine forms that I downloaded, including a test on medical-legal issues. From prior experience, I know the real fun will happen when I have my license and must get certified with every health plan in the new state.

Red Tape Hoops? Click for source

This week I found out that they will need to see my actual social security card. Like all good girls, I read the instructions on the card and put it in a safe place. Where that place may be is currently unclear, but I am sure the card remains quite safe. So today I filled out an application for a replacement card and brought my passport to the local Social Security office.

I was planning to run by on the way home yesterday, but I discovered the office closes at 4 pm.

So I request my card and show them the passport, the only single document that can confirm US citizenship for employment purposes. They hand me a print-out, and the birthdate is wrong. The clerk goes back through my history and discovers that in 1984, when my name changed with marriage, someone transposed the digits in my day of birth from "12" to "21." My original application in 1976 had "12" on it, as does every other form of identification I possess. I hand back my passport which includes the correct date of birth; however, birth date can only be established by an original birth certificate with raised seal. Never mind that the government put the date on my passport using my birth certificate - I must bring in the actual certificate between 9 am and 4 pm on a non-federal-holiday weekday to correct this information. Or mail in my official copy of my birth certificate and hope I do not need it for another hoop-jump in the coming 2 weeks.

I guess I should be glad that I found this now, when correcting it remains an annoyance, rather than when I needed to collect benefits. Still, I feel like I am jumping through hoops of red tape.

That feeling will only get worse as I start filling out these damn forms...

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Office Dinosaurs

Feb 14 2011 Published by under [Science in Society]

Harry Wallop (what a great name!) of The Telegraph recently published a list of 10 office items heading for extinction. I list them below with my thoughts:

Floppysaurus Rex? (Click for source)

1. Compact Discs - No argument here; even music will leave these coasters behind.

2. Memory sticks- Not so sure. The Mac Airs come with your back-up system software on a cute memory stick. I don't think we can quite reboot and restore a hard drive from the cloud yet.

3. Rolodex- Why haven't these been replaced already?

4. Personal diaries- See #3; I have been electronic-only for years now.

5. Calculator- Most of the time I use one built into my smart phone or iPad; however, every once in awhile a small calculator comes in handy.

6. Desk phone- Still there; the biomedical research and healthcare enterprise does not seem ready to cut all of their wires.

7. The Waste Paper Bin- Replaced by a recycle bin, but the concept lives on. Will people ever quit printing agendas or sending junk mail?

8. Shredders- Moving off-site for the most part. If we could get people to quit printing sensitive material, they might die off.

9. Mobile water coolers- People need water coolers and coffee machines to hang out and get creative in the work environment. The nature of the beast may change, but it will still be around.

10. Desktop hard drives- Something has to hold the operating system in the computer, and I do not see how we can get around it. I also sleep better knowing my data exists in the cloud, on my desktop hard drive, and on my laptop hard drive. Oh, and the desktop hard drive gets backed up to a terabyte pocket drive daily. Overkill? Perhaps; but I think we can all remember data on servers disappearing suddenly.

Of course, I remember the February 1 episode of RadioLab on NPR: Tools Never Die. (Click to listen to the full story). Basically, no technology, no matter how obsolete, cannot be obtained today. Whether hobbyists, Amish, or third-world, everything can still be purchased.

So don't trash your CD player yet. But share your thoughts below - will any of these (or perhaps other) office items be around in 10 years?

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Setting Records

Feb 12 2011 Published by under Uncategorized

Last night we helped set a record - for attendance at a hockey game in Nebraska.
15,137 of us watched the UNO Mavericks beat the Wisconsin Badgers 4 to 1.


College hockey is a fast fun game. Passing and speed rule the game. While players check hard, the outright fighting of the pro game is not tolerated.

One class of spectator from the pro game is absent from the college sport: the hockey bimbo. These women would wear a home team jersey over tights with stilettos or over-the-knee boots. Hair styles tended toward big and blonde. They always sat right behind the glass, and they frequently got chosen to shoot the puck in the between-period contests. They never drank beer.

Last night we rocked the Qwest center. Tonight we are off to the movies. Hope your weekend also comes with fun!

- Posted using BlogPress from my iPad

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Pitchers and Catchers Report Monday

Feb 11 2011 Published by under Fashion (or not)

So how far away can spring be, really?

After getting my veins whacked in December, my legs have healed quite nicely. I am more than ready to rock some skirts and cute shoes. While I can "shop" my own closet and wear those pairs that my feet had swollen too much for last year, one thing is stopping me:

Click for Source

All of those strappy, open-toed numbers do not play well with the white stuff that continues to cover much of Omaha's landscape.

While reality bites and I must wait for spring weather, I can still dream.

Bouquets Briar: $69 at Zappos

These satin kitten-heels come in a rainbow of colors, but this shade of green just screams "spring" to me.

Green like fresh shoots of tulips.

Green like a manicured infield.

I dream of green.

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