Issue 19: Tooth Sensor, the Interstitium, State of the Trump, and Gracilis

Tooth Sensor Tells You to Stop Guzzling Mountain Dew & Cheetos
Image from Tufts University Flo Omenetto
Engineers at Tufts University have created a 2mm square sensor that can be applied to the teeth to inform patients/providers what type of foods are being eaten. The sensor can recognize salt, sugar, alcohol, and Natty Lite (probably). The prototype consists of 3 layers and includes a bio-responsive sensor which will transmit specific radio-frequency signals based on the type of food it comes in contact with. Ultimately the team wants to further develop the device so that it can provide caloric intake estimations along with a breakdown of what you are eating. 

Everyone Who’s Not a Doctor (or Buzzfeed) is Freaking About this New Organ

Image of Interstitium from Eric V Grave on LIVE SCIENCE
Media outlets across the country have been hyping a recently published paper in Scientific Reports that describes a “new organ” called the interstitium. The interstitium is a collection of fluid and dense connective tissue underneath the skin that surrounds organs, muscles and the vascular systems. The scientists now claim that the interstitium has fluid filled spaces that are interconnected throughout the body which they theorize could serve as a highway for some cancers. Gastroenterologist Dr. David Carr-Locke of Weill Cornell Medicine and pathologist Neil Theise of NYU Langone were the lead authors of the study. They used an innovative new imaging technique called pCLE, which allowed them to visualize the interstitial structures surrounding bile ducts in living tissue. This allowed them to clearly visualize the interconnected fluid filled spacings. This is in contrast to the traditional histological imaging technique of slicing and fixing tissues for exam under microscopy, which has not allowed for clear visualization of the fluid compartments. If the researchers are correct about their findings and the rest of the scientific community can agree, then the interstitium will be our 80th organ. Still wanna know more? Here's a link to Buzzfeed.

Right-to-Try Bill: Who chooses drugs for the terminally ill?

Various medications
Medical students are taught to guide mortal patients and families through the Beautiful Exit, death. Whether it is a more postmodern euphemism of the age-old Hippocratic Oath of ‘First, Do No Harm,’ physicians are expected somehow to waddle through the fine line between providing the best care and timing for palliative care. But what is truly the best care and who gets to choose? While both doctors and patients are sometimes blinded to certain treatments or science simply has not caught up, drugmakers continue to boast about their newest development. Desperate patients want to try new drugs while doctors are careful. You get the point. Now, a recent House Bill backed by president Trump was passed that increased access for experimental drugs for terminally ill patients. However, the Senate rejected the vote for a bid this week. Keep in mind, though, the current protocol is to obtain approval from the FDA to try an unapproved drug, and the FDA apparently already approves 99% of them. Getting a great drug to pass the clinical trials is a feat, and equally great is a physician upholding safety for all. The tug of war will determine who has the most say in the decision making process.

Trump fires head of Veterans Affairs

Dr. David Shulkin became one of those Twitter moments for Trump. Known for his ambitious effort to reform the EHR system for Veterans Affairs hospitals, Shulkin had a pricey $1.1billion plan to make VA healthcare EHR system better again. Making claims about how the VA will lead the modernization of healthcare interoperability and security, he got people to believe that the government is perhaps more nimble than we thought. Receiving Wimbledon tickets and his wife going on a Eurotrip with taxpayer money perhaps won him a trip to Trump’s Twitter moment, joining many others. Or was it that Trump pushed for more privatization and expansion of the VA healthcare system through the VA Choice program, whereas Shulkin wanted to keep it tighter? However, maybe it all comes as less of a surprise knowing our POTUS’ predictably erratic behavior of firing his staff.

New government spending plan and healthcare
 
POTUS DT. Photo Cred: AP

If anyone remembers, our government was on a standstill about Dreamers and other issues, and almost went into one of those shutdowns because there was not enough budget $. Life is moving on in Washington, and a $1.3 trillion spending bill was passed last week. Let’s take a quick look at what the plan did for healthcare. Earlier, President Trump scared many doctors and researchers with the NIH funding cuts. But this budget plan, if anything, is a relief. By the numbers, NIH rather saw a $3 billion increase in funding from last year, the EPA did not lose funding, and the $4 billion bolus to combat the opioid epidemic will mostly go to the Substance Abuse and Mental Health Services Administration and the State Opioid Response Grants. We will also await the results of a new opioid legislation called CARA 2.0 in April. Oh, and the proposed $25 billion for the wall rather shrunk to $1.6 billion.

Say Cheese!

Gracilis muscle inset in 2-stage procedure for facial reanimation. Image Credit: JAMA.
You never really know what you have until it’s gone. Take your own smile, for example. There are many people who suffer from one-sided facial muscle paralysis from events like birth defects, stroke, tumors, and Bell’s palsy. This causes part of someone’s face to become nonfunctioning and for their smile to appear “droopy.” Surgeons from John Hopkins have been working to perfect a surgery to transplant gracilis muscle from a patient’s thigh tissue to the corner of the mouth and eyelid. This surgery has been very successful, helping 12 adult patients be able to smile again.

Doctors Talk: The Rarest Case I Saw in Medicine

"When I was a resident on Neurology a young woman (19 yrs) was admitted to the service.  She had a new-onset seizure at home and afterward was in an altered condition.  It was reported that she was grabbing the EMT personnel and pulling them into bed.  When on the Neurology floor she had to be restrained, as she was poorly responsive and exhibited continuous pelvic thrusting for about 24 hrs.  As she gradually got better she would speak normally, but she never failed to sexually proposition every man in her room on rounds.  Ultimately, CSF studies and neuro imaging revealed HSV-1 encephalitis involving bilateral temporal lobes.  Her behavior was felt to consistent with Kluver-Bucy syndrome that was produced by the bilateral temporal lobe involvement.  Memorable!"

~Dr. Morehead

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