Heart failure is a condition that affects over 1 million people in the UK. According to the British Heart Foundation, around 200,000 people are diagnosed with the condition every year. The condition tends to be managed through medications or through various surgical interventions, depending on the cause of the heart failure. However, in severe cases, these interventions may not be effective and a heart transplant may be the only option. As the waiting list for donor organs continues to grow, the medical world has been desperate to find another option.

Artificial hearts, once nothing more than an idea in the realm of science fiction, are now an exciting reality. Ventricular assist devices supplement the function of failing hearts by replacing one aspect of the heart, whereas total artificial hearts are created to replace the heart entirely.

The company SynCardia has created the first commercially approved total artificial heart. This innovative device replaces the ventricles and 4 valves of the heart. It offers hope and an extended life expectancy to patients with end-stage heart failure. The longest a patient has lived with a SynCardia total artificial heart is 6 years and 9 months.

An intriguing current prototype for a soft artificial heart is being researched by ETH Zurich. It is formed from silicone and was created using 3D bioprinting, in an attempt to mimic the human heart as closely as possible in its form and functionality. However, this heart has a lifetime of only 3,000 pumps – the equivalent of 30-45 minutes.

Despite these incredibly impressive innovations, there is a clear problem; artificial hearts have been created as a bridge to a donor heart transplant, and the code has not yet been cracked on how to create a permanent artificial heart.

One of the greatest difficulties is creating a device that can meet the demands of the heart. Total artificial hearts must pump 8 litres per minute of blood with a blood pressure of 110mmHg, which requires an enormous amount of power. (More statistics on requirements in this article) Additionally, the procedure may lead to infection and there are other devastating side effects. A functioning heart is an essential part of life; the creation of a permanent artificial heart replacement would undoubtably change the lives of millions worldwide.

One of those lives could potentially be mine. Heart failure is a condition that has impacted my family and is something that I am at higher risk of. It is comforting to know that there are many interventions in place for the condition, should I be in the position of needing them. The fear of needing a heart transplant is one that I think about at times. I hope to make an impact in the research of artificial hearts in future. When taking the issues with durability, infection risk and economic barriers into consideration, it seems as though the creation of a permanent, accessible artificial heart replacement is an idea of the distant future. But I like to view things optimistically; technology is advancing extremely quickly – perhaps there will be a breakthrough sooner than it is believed.

It is no secret that the UK faces a serious organ shortage. Approximately 7,000 people are on a waiting list for an organ, and just last year, 430 people died never receiving one . Strategies have been implemented to help boost the number of donations, such as the switch to an opt out system in the UK. As well as advancements in humanizing animal organs for use, such as the decellularization and recellularization of pig organs with human pluripotent stem cells (see bellow). Or the genetic modification of a pig heart in order to remove its ‘pig markers’, so that after transplant the heart is hidden from our immune system (as seen in David Bennet’s case). Or just straight up growing human organs in chimeric pigs! Hopefully with these advancement, in the future, donations for organs transplant will become obsolete. However, donations to science will always be in demand.

After getting the opportunity to view prosthetic implants in situ, I genuinely felt indifferent. I thought it would be interesting experience but not something that would leave a lasting impression on me, boy was I wrong! After arriving at Southampton General and traversing its maze-like corridors, down into the depths of the hospital. My nose was hit with the overpowering chemical smell and shortly after, I was exposed to a preserved human corpse… A WHOLE (bar their missing lungs) HUMAN CORPSE! [Which I later found out are called cadavers.]

Next I was taken to see the prosthetics in situ and the room resemble something comparable to that of a serial killers basement! Human body parts, preserved and exposing their prosthetics, everywhere! Although being warned about what I would see, being their first hand was such a surreal experience, but very educational and insightful. I even got to touch the specimens first hand, truly a once in a lifetime experience.

Coming away from this event, gave me such an understanding for why donating your body to science is so important. Hospitals will often use the donated bodies to aid with teaching and preparing surgeons for what they might see in theatre. For example, when performing a hip replacement surgery, it is one thing to read about where the prosthetic should sit in the body from text books and videos but getting to see it in person is an invaluable learning experience. I don’t know about you, but I would want my surgeon to have seen where my prosthetic needed to go in situ before they actually went through with the operation! Additionally some donation will go onto to be used as surgical practice for training medical professionals. Or, your body could be used In research, to help aid the progress our knowledge of the human body.

However, are hospitals and medical schools the only places that requires human bodies? When you agree to donate your body to science, will your body definitely be used to aid in the teaching of generations of doctors to come, or could it end up in a barrel?! A notion I would’ve laughed at, until I stumbled across these macabre facilities known as body farms.

Body farms are forensic research facilities that aim to progress our knowledge and understanding about human decomposition. These facilities involve placing bodies in different situation and environments whilst monitoring how they decompose. Data gathered from body farms go onto aid police in determining what may have happened at crime scenes. The UK currently doesn’t have a body farm but there are talks about setting one up.

When it comes down to it, whether you wish to donate your body to science is your own personal choice and you can see mine bellow.

Stem cells have always been an intriguing topic to me, particularly their therapeutic potential. The idea of being able to use one undifferentiated cell to create whole new organs or body parts is fascinating. After our lecture on stem cells and their therapeutic use, I decided to research the different ways that stem cells are currently being used in medicine, and one case in particular stood out.

The Story

Lesley Calder was diagnosed with acute myeloid leukaemia in 2019. Chemotherapy treatment was unsuccessful for her cancer, and she was left with the only option of a stem cell transplant. Lesley’s three siblings volunteered to be tested, with the slim chance of finding a sibling match (~25%). By some miracle, 2 siblings were full matches and 1 was a half match. Lesley’s sister Annie was chosen to be the donor, and amazingly, Lesley has since made a full recovery.

Using Stem Cells to Treat Cancer

A stem cell is defined as a cell that can self-renew indefinitely and has the capacity to differentiate into many cell types. Their normal function within the body is to replace old, damaged or defective cells to maintain normal tissue function.

Stem cell transplants are used to treat diseases where the bone marrow is damaged or defective, meaning that healthy blood cells can no longer be produced. This is the case in blood cancers (e.g. leukaemia and lymphoma), which primarily affect white blood cells. The loss of blood cells is further exacerbated by intensive cancer treatment (e.g. chemotherapy), which can also damage/destroy healthy cells. The transplantation of stem cells produces new blood cells, and helps to defend against the cancer.

Stem Cell vs. Bone Marrow Transplants

Before this research, I had only heard about bone marrow transplants, and didn’t know stem cell transplants existed, which made me wonder what the difference is. They are essentially the same thing, but differ in the locations where the cells are collected. A stem cell transplant involves collecting stem cells from the bloodstream, which is less invasive than a bone marrow transplant, which involves collecting a person’s bone marrow from within their bone (usually pelvic).

Information from Cancer Research UK says that stem cell transplants are the more common of the two, which I found surprising, considering I hadn’t heard of them. This is because stem cell transplants are: less invasive, easier to perform, have a higher yield of cells and have a quicker blood count recovery.

The Problem & Final Thoughts

Through this research, I have found that over 70% of patients who require a stem cell transplant will not find a compatible donor in their family. Additionally, only 3% of the UK population (and <6% of people in Northern Ireland) are registered to be stem cell donors, making the chances of finding a compatible match even lower. For the majority of patients, like Lesley, a stem cell transplant is their only chance at recovery, and their chances of success are slim.

Lesley’s story prompted her son Max to join the stem cell donor register in hopes of helping others like his mum, and he has already been called upon to donate. By sharing her story, I hope to inspire others to join the register as well, as I will definitely be doing. Anyone aged 17-55 and in good health can sign up here. For more information on stem cell transplants, visit NHS, Cancer Research UK or Leukaemia & Lymphoma Society.

In the UK, 12 million people are affected by hearing loss. 80 million are over the age of 60. Over 900,000 people are severely or profoundly deaf, they are unable to hear any speech. During this module, lectures were given on cochlear implants. My interests on these grew so I decided to do some further research. Cochlear implants are used by 12,000 people in the UK.

How do they work?

A cochlear implant is an electronic device that helps with understanding speech and sensing sounds. There are 4 parts: a microphone, a speech processor, a transmitter and receiver-stimulator and an electrode array. The external speech processor captures sound and converts it into digital signals. The digital signals are sent to the internal receiver-stimulator. The signals are converted into electrical energy which is sent to the electrode array that’s inside the cochlea. The electrode array stimulates the auditory nerve by bypassing damaged hair cells. The auditory nerve transmits signals to the brain. These signals are recognised as sound.

Cochlear Implant

Image of CI

Who gets them?

Cochlear implants are given to those that are congenitally deaf, had an infection associated hearing loss such as measles, trauma associated hearing loss like a head injury, age associated hearing loss and people who do not benefit from hearing aids which can be confirmed by specialised hearing tests.

Benefits and challenges

Cochlear implants are given from 6 months old. This is beneficial for children as they are learning to speak and process language. People will be able to hear speech without reading lips including phone calls. They can hear everyday sounds like the noise made when there is a green man at the traffic light. This improves their safety. Cochlear implants help people develop their speech and pronunciation as they can hear their own voice, improving their communication.

There are a few risks, one is meningitis which can occur after implant surgery. This is prevented by vaccinations beforehand. Another, is the results vary depending on the person. Some people’s hearing significant improves while others don’t receive such satisfaction. Cochlear implants are not an instant fix, time is needed for the brain to get used to how they work.

Technology

Cochlear implants are becoming more advanced with technology. Sound processors can be waterproof meaning children and adults can enjoy swimming and even bathe without worrying about any damages. They can be paired with phones through Bluetooth. Sounds can be wirelessly streamed to the processor. An example is the Nucleus® 8 Sound processor which uses improved technology to sense changes in the environment and can adjust listening settings.

Nucleus® 8 Sound processor

Advanced bionics have a cochlear implant called the HiRes Ultra 3D cochlear implant. This device works with technology, making speech clearer and music with better quality sound.

My opinion

Overall, my thoughts on cochlear implants are that they are amazing as they can help deaf people have a better quality of life. I think that they are accessible in the UK due to the NHS and I was surprised to discover that in the US, they can cost between $50,000-100,000. I was appalled by this as many adults and families with children cannot afford such high prices so they won’t get the benefits of cochlear implants. I love that with technology, the external parts of cochlear implants are smaller so people can participate in sports easily. I’ve been to competitions where I saw children with sound processors and I was happy to see them get the same opportunities and experiences as everyone else. I’m excited to see how cochlear implants will further advance.

The pillars of consideration to providing this surgery involve: beneficence, assessing whether patient’s lives will get better through surgery; non-maleficence, assessing whether risks and potential complications of surgery are worth it (in both short and long term rehabilitation); autonomy, allowing patients evaluation on the most appropriate treatment including informed consent, ensuring patients are comprehensively aware of all courses of treatment and associated risks and benefits; professionalism, in adhering to the highest standards of practise; justice, providing equitable distribution and access to resources regardless of their demographic.

Working in trauma and orthopaedics, I often consider whether prosthetic joint replacement is beneficial in the context of neurodegenerative disorders. I have had difficulty in assisting patients that undergo, for instance, hip replacement and day one post-operatively forget they have undergone the surgery. This can involve mobilising prematurely, potentially jeopardizing the integrity of treatment they have received by dislocating or loosening the implant, delaying the healing process, increasing infection or thromboembolic risks, advertently causing more pain and discomfort. This occurs regularly and can be problematic, with excessive treatment and only DOLS (deprivation of liberty safeguards) to prevent postoperative complications. This can traumatise patients who aren’t aware of their circumstances leading to feeling of emotional discomfort, isolation, and lashing out against those trying to help them.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9619389/ – find here a comprehensive pubmed publication into the impact of parkinsons disease on the outcomes of total knee replacement

Despite obligations to provide every patient treatment without discrimination, even with ability to use longer term implants like metal on plastic for patients that expect to benefit from the replacement more (those more mobile) compared to shorter term ceramic prosthetics, how far is the surgery beneficial at all considering the cost and compounding factors to those that will not fully understand or appreciate their treatment and could potentially put it in jeopardy?

https://ebjproliancesurgeons.com/blog/understanding-the-different-types-of-hip-implants/ – find here criteria and description for different joint prosthetic media

Could investment for those with neurodegenerative disorder be better spent on research that can prevent higher incidence of falls, reducing the need for surgery at the source? Could it be better invested in mitigating incidence of falls in care by providing more effective infrastructure in place for this? Could investment be better spent elsewhere where the NHS falls behind for those that may truly understand and appreciate their treatment? This decision operates on a fine line and operates on the boundary of what is ethically right.

Ultimately, I have learnt that our obligations to everyone regardless of their demographic or cognitive state are considered equal. Besides, are we not obliged to those suffering from neurodegenerative disorder that were part of the generation that built and paid for the NHS throughout their lives? However, paradoxically, I would consider higher selectivity in providing such surgical treatments as i believe it could be more beneficial elsewhere in patient outcomes and development would lead to better future outcomes for these patients.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/414360 – find here a comprehensive study into decision making, procedure, and outcomes of joint surgery in elderly patients with osteoarthritis

With over 3 billion people in the world living with a neurological condition, the pressure for improvements to be made in this field continues to increase. With my grandfather being one of the many people affected, I am personally intrigued in current and future developments to come. Let’s delve into the interdisciplinary approach of biomedicine and engineering for the recovery of neural diseases.

Neurological disorders

The brain and spinal cord are the control centres of the body, sending and receiving sensory and motor information. When this system dysfunctions, it leads to disease. A few examples of neurological disorders are the following:

•Spinal injuries: caused by traumatic damage to the spinal cord, resulting in loss of motor or sensory function, often causing paralysis or impaired mobility.

•Neurodegenerative diseases: include the progressive conditions affecting nerve cells, leading to deterioration of cognitive or motor function, as seen in Alzheimer’s, Parkinson’s and Huntington’s disease.

•A stroke: the sudden interruption of blood supply to the brain, causing rapid loss of brain function, leading to paralysis, speech and vision problems, or death.

The use of biomaterials

The use of human embryonic stem cells for therapeutics to aid brain disorders has come with success but raises ethical questions. It can be argued that the development of biomaterials is a better approach.

•For the treatment of spinal injuries, neural grafts and biomaterial scaffolds are employed for functional recovery, physical support and help foster axonal regeneration. Strategies like electrical stimulation and growth factor delivery further aid neuronal regrowth.

•Neurodegenerative diseases prompt the development of 3D brain tissue models, organoids and neural implants to understand disease mechanisms whilst stem cell therapies, including induced pluripotent stem cells (iPSCs), restore neural function.

•Stroke therapies utilise biomaterial scaffolds and injectable hydrogels to promote neuroprotection and enhance functional recovery.

Hydrogels: application in stroke recovery

Hydrogels provide therapeutic benefits through drug delivery, tissue regeneration and wound healing, including direct injection into stroke cavities and forming protective barriers in the brain post-stroke.

Derived from natural or synthetic polymers, they form a 3D structure, absorbing biological fluids within the body. They are flexible and resemble tissues which can be tailored for specific applications. They also play a crucial role in aiding neurological regeneration for stroke patients through multiple mechanisms.

Firstly, they provide a scaffold for cells to adhere to and grow within, facilitating cell migration and tissue regeneration. Secondly, hydrogels can deliver therapeutic agents (growth factors and stem cells), promoting neuronal survival, angiogenesis and modulation of the inflammatory response, essential for recovery. Thirdly, their biocompatibility ensures sustained release of therapeutics without adverse immune reactions. Lastly, their physical properties can mimic the brain’s native tissue environment, fostering appropriate cellular behaviour and functional recovery. In essence, hydrogels offer a versatile platform for neurological regeneration.

Things to consider

Concerns linger over longevity, immune rejection, and unforeseen risks of biomedical interventions. Legally, adherence to regulatory frameworks, patent protection and insurance coverage are paramount for ensuring safety and accessibility. Ethically, emphasis lies on informed consent, equitable access, especially in developing nations and addressing social injustices. Who deserves this treatment and why?

My final thoughts

Whilst all sides present a fair argument, I am inclined to take the equitable approach in providing access to these treatments. The choice should be with the patient, neither the law or the socioeconomic circumstances of the individual should intrude on their autonomy or dictate their access to treatment. However in reality this is not always the case.

The long term effects of using biomaterials, particularly hydrogels are a controversial topic. Nevertheless, their use for stroke treatment has shown promising potential, with wider applications to other neurological cases. Caution should be taken with experimental treatments as their long term effects remains to be seen.

Hearing – a natural ability we possess and one of the five senses crucial to human experience. Yet, it is often overlooked. Hearing loss is an invisible disability affecting 1-in-6 adults in the UK. This sparked my curiosity about how hearing loss, whether congenital or acquired, impacts quality of life. Especially in terms of its social aspects. This article published in May 2022 states that factors such as “differences in cognitive abilities and age-related changes may exacerbate the problem”.

What Are Cochlear Implants?

A cochlear implant is a small yet complex electronic device designed to provide a sense of sound to individuals who are profoundly deaf or severely hard of hearing. It consists of an external component placed behind the ear and a second component surgically implanted under the skin.

How Do They Work?

As shown by the diagram above, cochlear implants consist of a microphone which captures sound from the surroundings. Detected sounds are sorted and organised by a speech processor. A transmitter and receiver/stimulator then receives signals from the speech processor and transforms them into electrical impulses. These impulses are gathered by an electrode array and transmitted to various sections of the auditory nerve and finally to the brain which recognises the electrical impulses as sound.

Quality of Life

During my research, I found that one aspect to consider within the deaf community is listening effort – referring to the cognitive exertion required to understand and process auditory information. If it is more challenging to hear, it must also be exhausting to communicate. While it may require some acclimating, with the use of cochlear implants, the ability to engage in social settings becomes possible. This can significantly improve quality of life for deaf individuals by reducing the need to be in a constant state of high listening effort.

Individuals with hearing loss often face challenges with employment leading to socioeconomic disparities. Statistics show that the employment rate for those with hearing loss stands at 65%, in contrast to 79% for those without any long-term health issues or disabilities. These figures reflect the situation in the UK – a well-developed country. However, differences in employment rates may be greater in less-developed countries with limited access to healthcare facilities and lack of awareness about hearing loss. A study from Cambridge University found that individuals with cochlear implants reported higher levels of employment and income.

The Downside

Perspectives on deafness vary among individuals. I found this article particularly captivating as it delves into how some may embrace deafness as a cultural identity. The deaf community have developed their own mode of communication over centuries through sign language. To them it is not simply a means of communication but also a part of belonging to a community.

The widespread use of cochlear implants raises concerns within this community about the potential loss of their language and culture. In fact some deaf parents go as far as to request pre-implantation genetic diagnosis (PGD) to ensure their children will be born deaf, and thus take part in their culture and lifestyle.

Conclusion

Cochlear implants overall represent a remarkable advancement in technology for individuals with hearing loss. While they may not be a cure-all, they have the potential to enhance quality of life by restoring access to sound and facilitating better communication. However, it is crucial to recognise that the decision to pursue cochlear implants is deeply personal and not every deaf individual may choose to use one.