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Technology
MedicineTechnology
Medicine
Richard M. Satava, MD FACSProfessor of Surgery
University of Washingtonand
Senior Science AdvisorUS Army Medical Research and Materiel Command
Richard M. Satava, MD FACSProfessor of Surgery
University of Washingtonand
Senior Science AdvisorUS Army Medical Research and Materiel Command
4to Simposium Internacional Ingenieria Biomedica Biomedical Engineering Students Society
Monterrey, MexicoMarch 7, 2008
4to Simposium Internacional Ingenieria Biomedica Biomedical Engineering Students Society
Monterrey, MexicoMarch 7, 2008
andand
PPresenter resenter DDisclosure isclosure SSlidelide**
Richard M. Satava, MD FACS
METI, Inc
Preimera BC/BS
InTouch Technologies, Inc
Karl Storz
Stryker
SimuLab
US Surgical
* There will be no discussion of any products from these companies
…
…
To
From
Greetings from MontereyCalifornia
“The Future is not what it used to be”
….Yogi Berra
“The Future is not what it used to be”
….Yogi Berra
Disruptive Visions
“The Future is here …
. . . it’s the Information Age”
“The Future is here …
. . . it’s the Information Age”
Current Visions
New technologies that are emerging from Information Age discoveries are driving our basic approach in all areas of healthcare education
. . . EXAMPLES
New technologies that are emerging from Information Age discoveries are driving our basic approach in all areas of healthcare education
. . . EXAMPLES
Fundamental Concept
Information basis for Medicine
Borrow from Industry – eg,CAD/CAM
Information basis for Medicine
Borrow from Industry – eg,CAD/CAM
The Fundamental Change
Medical education has only begun to realize the potential
Why Robots?
The Touch Lab, MITMovie: Alien
HolomerTotal body-scan
for total knowledge
Satava March, 2004Virtual Soldier Program
Information Representation of a PatientInformation Representation of a PatientMedical equivalent of CAD/CAMMedical equivalent of CAD/CAM
Multi-modal total body scan on every trauma patient in 15 seconds
Virtual Autopsy . . .
Wound Tract
Less than 2% of hospital deaths have autopsy
Statistics from autopsy drive national policies
. . . is a SIMULATED Autopsy. . . is a SIMULATED Autopsy
Why modeling & simulation, imaging and robotics• Healthcare is the only industry without a computer representation of its “product”
•A robot is not a machine . . .it is an information system with arms . . .
• A CT scanner is not an imaging system it is an information system with eyes . . .
thus
• An operating room is an information system with . . . * “The Information Age is about changing from objects and atoms to bits & bytes”
Nicholas Negroponte “Being Digital” - 1995
Total Integration of Surgical Care
Courtesy of Joel Jensen, SRI International, Menlo Park, CA
Minimally Invasive& Open Surgery
Pre-operative planningSurgical Rehearsal
Intra-operative navigation
Remote Surgery
Simulation & TrainingPre-operative Warmup
Information and computersCornerstone of Systems Integration
Single instrument which
- performs both diagnosis & therapy - in real time - can be autonomous
Single instrument which
- performs both diagnosis & therapy - in real time - can be autonomous
Surgical MEMS - Smart Surgical Tools
Instrumented ScalpelInstrumented ScalpelXACTIX
XACTIX
CONVENTIONAL
MEMS SharpsMEMS Sharps
Courtesy: E.C. Benzel, L.A. Ferrara, A.J. Fleischman, S.Roy
From tissue and instruments
to
Information and energy*
From tissue and instruments
to
Information and energy*
* “The Information Age is about changing from objects and atoms to bits & bytes”Nicholas Negroponte “Being Digital” - 1995
The Fundamental Change
“TriCorder” Point-of-care noninvasive therapy
High Intensity Focused Ultrasound for
Non-invasive Acoustic hemostasis
HIFU
Courtesy Larry Crum, Univ Washington Applied Physics Lab
Mechanics to energy
Courtesy Larry Crum, Univ Washington Applied Physics Lab2003
The LSTATLife Support for Trauma and Transport
Courtesy of Integrated Medical Systems, Signal Hill, CA
“ . . . with a fully functional ICU ”
• Defibrillator
• Ventilator
• Suction
• Monitoring
• Blood Chemistry
Analysis
• 3-Channel Fluid/Drug
Infusion
•Data Storage and
Transmission
• On-board Battery
• On-board Oxygen
• Accepts Off-Board
Power and Oxygen
Total Patient Awareness
Bring the hospital to the casualty, not the casualty to the hospital . . .
212th MASH Deployed with LSTAT - Combat Support Hospital
LSTAT Deployment to Kosovo - March 2000
Courtesy of Integrated Medical Systems, Signal Hill, CA
Nightingale UAV Goal Identify “optimum” VTOL UAV design Create a new VTOL UAV tailored to the operational need
LSTAT
Aeromedical evacuation
Why now?VTOL UAV technology is maturing rapidly enough to minimize risk.
We need: New “tools” for the new procedures New simulators for education and training
We need: New “tools” for the new procedures New simulators for education and training
Disruptive Technology in SurgeryN.O.T.E.S.
Natural Orifice Transluminal Endoscopic Surgery
Trans-Gastric Surgery
New surgery for great new opportunities
Trans Oral Intra-peritoneal Surgery - Future
Courtesy of N Reddy, Hyperbad India 20005
Early Luminal Malignancies - Robotic Endoscopic Mucosal Resection - EMR
Courtesy of N Reddy, Hyperbad India 20005
Trans-gastric appendectomy
Courtesy of N Reddy, Hyperbad India 20005
What next?
It’s all about the man-machine interface
Courtesy Lee Swanstrom, MD Portland OR 2007Courtesy Lee Swanstrom, MD Portland OR 2007
Tele-endoscopy. Controlling micro-robot (which has been inserted into the rectum) from endoscope workstation
Conventional colonoscopy
Future EndoscopicWorkstation?
[ Courtesy R Satava, GI Clinics North America, 1983]
Endo-vascular work station – by Hansen Medical, Inc
URL http://hansenmedical.com Feb, 2007
Classic Education and Examination
What is the REVOLUTION in surgical education?
Objective Training of Technical SkillsSimulatorsCurriculum
Assessment of Cognitive and Technical SkillsCriterion-based toolsObjective metrics
Objective Training of Technical SkillsSimulatorsCurriculum
Assessment of Cognitive and Technical SkillsCriterion-based toolsObjective metrics
Two components of revolution
Military role in medical simulation
1992 – 2002
1992 - present
TATRC
The Dream of Simulation - Aviation
Current commercial simulatorEdwin Link - 1939
The RealizationThe Dream
The Dream of Simulation – MedicineVirtual Reality & Head Mounted Displays
Wearing HMD for prolonged timeNASA original HMD
The RealizationThe Dream
The Dream of Simulation – MedicineVirtual Reality & ‘Immersive Environment’
Immersive VR today ?Courtesy A VanDam, Brown U, 2005
First immersive VR Surgical SimulatorCourtesy .Satava - 1987
The RealizationThe Dream
Mannequin-based Simulator - Realistic physiologic responseIndividual and Team Training
Human Patient Simulator 2005Courtesy METI, Inc Sarasota, FL 2006
First Mannequin VR Simulator – David Gaba 1984Courtesy MedSim, Inc - 1991
The Realization
The Dream
• Change the anatomy (incl patient specific)• Realistic tissues for surgery (one time use)• Only simple invasive procedures (trach,etc)• Integrate into surgical systems (rehearsal)• Automatic objective assessment
• Change the anatomy (incl patient specific)• Realistic tissues for surgery (one time use)• Only simple invasive procedures (trach,etc)• Integrate into surgical systems (rehearsal)• Automatic objective assessment
Manikin SimulatorsLimitations and Challenges
Provides all levels of simulation
Integrates into current procedural systems
Surgical Rehearsal in clinical practice
Provides all levels of simulation
Integrates into current procedural systems
Surgical Rehearsal in clinical practice
Disruptive SimulationVirtual Reality Simulators
Laparoscopic Simulator with tactile feedback Courtesy Murielle Launay, Xitact, Lausanne Switzerland
Laparoscopic hysterectomy Courtesy Michael vanLent, ICT, Los Angeles, CA
LapSim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000
SurgicalSimulators
Simulation Incorporates Training and Objective Assessment
Dermatology SimulatorsPre-operative planning
• Strong collaborative environment
• UW Dermatology– Daniel Berg
• Human Interface Technology Laboratory (HIT lab)
– Suzanne Weghorst
– Peter Oppenheimer Virtual Reality Suturing Simulator
Computer-based wound planning
Endovascular Simulators(Surgical rehearsal)
Graphicoverlay
Patient specific image
OPERATIONALTEST &
ASSESSMENT
MISSION REHEARSAL
Pre-HospitalGround
Ambulance
Hospital Ward
EmergencyDepartment
Air Ambulance
Operating Room
Critical Care
OPERATIONALTEST &
ASSESSMENT
MISSION REHEARSAL
Point of InjuryCasualty
Collection Point
Combat SupportHospital
BattalionAid Station
GroundAmbulance
ForwardSurgical
Team
Air Ambulance
Virtual Hospital
Combat Trauma TrainingChain of Survival
Medical Simulation Training Center (MSTC)Madigan Army Hospital, Ft. Lewis, WA
Civilian Hospital TrainingChain of Safety
Riverside Hospital Simulation CenterColumbus Ohio
Courtesy of METI, Inc , Sarasota, FL - 2004
Pacific Northwest Simulation ConsortiumWWAMI: Washington, Wyoming, Alaska, Montana, Idaho
University of British Columbia, Vancouver, BC
Oregon University of Health Sciences, Portland, OR
VA
MadiganAMC
Harborview
Children’s
Cheyenne
Billings
Boise
Spokane
Anchorage
ISIS University
Washington
Seattle
of
WWAMI Represents 27% of entire land mass of USA
Vancouver
Portland
2015
Objective Assessment ofCognitive and Technical Skills
• Cognitive: Use Standard Testing MethodsMultiple Choice, Case Based, etcObjective Structured Clinical Exam (OCSE)
• Technical: Opportunity for new methodsStandard simulated objects, animal partsComputer-enhanced systems (manikin, dragon)Virtual Reality Systems
Objective Assessment of Technical Skills
Objective Structured Assessment of Technical Skills – OSATS Objective Structured Assessment of Technical Skills – OSATS Richard Reznick, Univ of TorontoRichard Reznick, Univ of Toronto
Laparoscopic Simulator SurgicalSIMCourtesy METI, Sarasota, FL
Laparoscopic hysterectomy Courtesy M vanLent, ICT, Los Angeles, CA
LapSim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000
Simulation and Objective Assessment
Cognition from Psychomotor
“Red Dragon”“Blue Dragon” passive recording device
Courtesy Blake Hannaford, PhD University of Washington, Seattle
Hand motion tracking patterns Ara Darzi, MD. Imperial College, London, 2000
Novice
Intermediate
Expert
Objective Assessment
MEMS based tracking, RFID, etc
Ara Darzi, Imperial College, London, 2005
Inferring Judgment
Can we understand what you are thinking?
Paradigm Change All Surgical Education & Training
• Adhere to the 6 competencies (ACGME & ABMS)
• Curriculum, not the simulation
• Validation of the curriculum (and simulator)
• Objective assessment
• Criterion-based (proficiency level) training
for
The 6 Competencies2001 Consensus by the AGCME & ABMS
• Knowledge
• Patient Care
• Interpersonal and communication skills
• Professionalism
• Practice-based learning and improvement
• Systems-based practice
Standardized Curriculum
• Goals of the Simulation• Anatomy• Steps of the Procedures• Errors TEST• Skills Training• Outcomes
Suggested template
The American College of Surgeons
• Embraced simulation and assessment for skills Collaborated with the Residency Review Committee to require simulation for all residency training programs
• Committee on Simulation CurriculaBegun development of standardized curricula (with American Board of Surgery)
• Committee on Certification of Simulation CentersCertify and endorse applicant centersLevel 1: Comprehensive CenterLevel 2: Basic Training Laboratory
Future Directions of Simulation
• Pre-operative planning
• Pre-operative warm-up
• Surgical rehearsal
• Intra-operative assistance (incl navigation)
• Automatic assessment and outcomes analysis
. . . all occurring at the surgical workstation. . . all occurring at the surgical workstation
Total Integration of Surgical Care
Courtesy of Joel Jensen, SRI International, Menlo Park, CA
Minimally Invasive& Open Surgery
Pre-operative planningSurgical Rehearsal
Intra-operative navigation
Remote Surgery
Simulation & TrainingPre-operative Warmup
Eric LaPorta, Barcelona, Spain 2005
New Concepts for OR of the Future“The OR Without Lights”
“Penelope” – robotic scrub nurseMichael Treat MD, Columbia Univ, NYC. 2003
ROBOT SURGICAL TECHNOLOGIES, INC
Currently in Clinical Trials
Integrating Surgical Systems for AutonomyThe Operating Room (personnel) of the Future
Surgeon Assistant Scrub Nurse Circulating nurse
100,000
Borrowing from the standard practices of other industries
Demonstration of Phase 1
Operating Room with no People
SRI International, Menlo Park, CA January, 2007
Demonstration of Phase 1
Operating Room with no People
SRI International, Menlo Park, CA January, 2007
SATAVA 7 July, 1999DARPA
Fighter Pilots – until 2002 Fighter Pilots – Beyond 2003Predator 2003
28 Training & Simulation Journal August/September 2006
“Remote Pilots”
A last bastion of guts-and-glory aviation is falling, as the U.S. Air Force prepares to unveil a new breed of unmanned aircraft pilots. Known as “remote pilots”, they’ll wear wings. They’ll fly aircraft. But chances are many will never climb into a cockpit. . Senior leaders have yet to approve the new Undergraduate Remote Pilot Training (URT), but Air Force officers familiar with the project expect approval by the end of the year. Instead of sticking reluctant manned aviators behind a console, the Air Force will groom remote pilots from the start to fly what the service now calls unmanned aerial systems
Robotic Medical Assistant
SATAVA 7 July, 1999DARPA
Nursing shortage crisis
Applicable at all levelsHospitalsClinicsNursing HomeAssisted living
Courtesy Yulun Wang, InTouch Technologies, Inc, Goleta, CA
Disruptive Visions
http://depts.washington.edu/biointel
“The Future is not what it used to be !”
- Yogi Berra
SATAVA 7 July, 1999DARPA
The Information Age is NOT the Future
The Information Age is the Present ...
There is something else out there . . . .
Scientific Method . . .. . . is DEAD?
HISTORYObservation, PhenomenonExperimentScientific method, …?
Not all science is explainable using scientific methodIntuitionCreativityQuantum mechanics
What comes BEFORE the hypothesis?
Observation, phenomenon, experiment, scientific method, …?
A new “science” may need to be invented
THE STRUCTURE
OF SCIENTIFIC
REVOLUTIONS
THOMAS S. KUHN
SCIENTIFIC METHODControlled, randomized, double-blind trial
Control GroupNo Parachute
Test GroupParachute
Still looking for volunteers for the control groupStill looking for volunteers for the control group
Scientific MethodA Paradigm Change?
Hypothesis Study Design Experiment Results Reporting
Hypothesis Study Design Modeling & Experiment Results Reporting Simulation
Modeling & Simulation
Clayton M Christensen
BIO-INTELLIGENCE AGET
EC
HN
OL
OG
Y
DE
VE
LO
PM
EN
T
CONSUMER ACCEPTANCE
AGRICULTURAL AGE
INDUSTRIAL AGE
BIOINTELLIGENCE AGE
INFORMATION AGE
TIME (year)
2000 BC 0 2000 AD190018001500
Satava 29 July 99
BIOLOGIC PHYSICAL
INFORMATION
FUTURE
RoboticsHPCC/WWWMEMS/Nano
GenomicsBioinformaticsBiocomputation
BiosensorsBiomaterialsBiomimetic
Satava 2 Feb 1999
BIO-INTELLIGENCE AGE
¿And just what are these incredible new technologies?
University of Wisconson, 1999
Biomimetic Micro-robot
Courtesy Sandia National Labs
Capsule camera for gastrointestinal endoscopy
Courtesy Paul Swain, London, England
Courtesy D. Oleynkov, Univ Nebraska
Courtesy Danny ScottTexas SouthwesternDallas, TX
Cold Spring Harbor Laboratory, Long Island, NY
Femtosecond Laser(1 x 10 –15 sec)
Time of Flight Spectroscopy
Cellular opto-poration
Los Alamos National Labs, Los Alamos NM
Surgical console for cellular surgery
Courtesy Prof Jaydev Desai, Drexel Univ, Philadelphia, PA 2005
Surgical console for cellular surgery
Courtesy Prof Jaydev Desai, Drexel Univ, Philadelphia, PA 2005
Motion Commands
Courtesy: Rahul G. Thakar, Ph.D. 2007
Molecular Imaging BioSurgery
Simulataneous multifunctional –6 different fluorophores in a cell
Roger Tsien, UC-San Diego, La Jolla, CA 2006
Monitoring
Fluorescent antibodies (GFP and anti-tumor) – rat model
Whole body visualization
Monitoring
Fig. 2. Top: Fluorescent micrograph of the actin cytoskeleton of an engineered striated muscle cell. Bottom: AFM-acquired topographical map. Wrinkles and lines along the diagonals of the 30 micron square are actin stress fibers under the lipid membrane surface.
Fig. 3. Schematic illustrating the technique for functionalizing AFM tips to identify specific molecules on the cell surface during raster scanning.
Fig. 4. Nanoincision by electroporation. (A) The AFM cantilever is positioned above a region of interest in the cell. (B) Electrical current is injected through the cantilever tip, causing the formation of a nanometer scale pore in the membrane, thru which the AFM tip can be dropped, or other instrumentation attached to the tip, prior to the membrane resealing.
New Surgical Tools
Courtesy Prof Kit Parker, MD, Harvard Univ, Boston, MA 2005
Atomic Force Microscope ManipulatorFemtosecond Lasers
Surgical Cockpit
Greg Kovacs. Stanford University, 1990
“BrainGate” John Donohue, Brown University, 2001
Richard Andersen, CalTech, 2003
Recorded activity for intended movement to a briefly flashed target.
TARGET MOVEMENT
Time
PLAN
Courtesy Richard Andersen, Cal Tech, Pasadena, CA
Brain Machine Interface – Controlling motion with thoughts
Miguel Nicholai, Duke University, 2002
Direct brain implant control of robot arm
Sterilization without supplies
Live/dead before and after treatment
Determine efficacy of inactivation of parasites
20-second treatment: near-complete promastigote inactivation
0.00E+00
1.00E+08
2.00E+08
3.00E+08
4.00E+08
5.00E+08
Pro
mas
tig
ote
co
nce
ntr
acti
on
(1/
ml)
Before treatment 3.48E+08 2.36E+07 3.72E+08
Plasma-treated 8.40E+06 3.80E+08 3.89E+08
alive: dead: total:
Insure safety of other cells and tissues
Leishmanaisis
a) Rheo Bionic knee Ossur, Reyknavik, Iceland
b) C-leg Otto Bock, Minneapolis, MN
Intelligent Prostheses Tissue Engineering
Liver Scaffolding Artificial Blood Vessel
J. Vacanti, MD MGH March, 2000
Artificial Ear
Replacing human body parts
Organs
urothelial and smooth muscle cells that are capable of regeneration are isolated.
The isolated cells are cultured separately until there are a sufficient quantity.
The cultured cells are properly seeded onto a biodegradable scaffold shaped like a bladder.
Quality assurance that the cells attach and grow properly throughout the scaffold. After about 8 weeks, the neo-bladder construct is returned to the surgeon for implantation.
The neo-bladder construct is implanted by the surgeon using standard surgical techniques.
The body uses the neo-bladder construct to regenerate and integrate new tissue, restoring the bladder’s functionality.
The biodegradable scaffold dissolves and is eliminated from the body, leaving a functioning bladder made only of the patient’s own newly regenerated tissue.
A surgeon takes a small, full-thickness biopsy from the patient’s bladder.
Courtesy of Tengion East Norrington, PA 2007.
Neo-bladder – a commercial synthetic bladder
Tegion,
Commercial Products
Spider silk protein as biomaterial -BioSteel
Nexia Biotechnologies, Montreal Canada
Cross section of synthetic fiber
Spinnerette of spider
Orb spider - web
Genetically re-engineering the body
Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02
Institute of Arctic Biology’s
Toolik Field Station,
Alaska's North Slope
Suspended Animation ( Auto-anesthesia - FRAMR )
metabolic rate 0.5 0.01 (2%)
active hibernating
body temp. 37oC -2oC
gene ongoing transcription function and translation suppressed
heart rate 300 3
resp. rate 150 <1 (breaths/min)
(beats/min)
(mlO2/g/h)
Alternative
Confidential
If you are not making mistakesyou are not working hard enough … … and that’s a big mistake! Anonymous
Experience is the name everyone gives to their mistakes - Oscar Wilde
Be careful ofunintendedconsequences
• The rate of new discovery is accelerating exponentially
• The changes raise profound fundamental issues
• Moral and ethical solutions will take decades to resolve
Technologies will change the Future
Differing responses to scientific discovery by various sectors
TIME
Rat
e o
f C
han
ge
Society
Business
Sector
Technology
Healthcare
Technology is Neutral - it is neither good or evil
It is up to us to breathe the moral and ethical lifeinto these technologies
And then apply them with empathy and compassionfor each and every patient
The Moral Dilemma
February 12, 2004
South Korean team demonstrates cloning efficiency for humans similar to pigs, cattle | Thersa Tamkins
After outlandish claims, a few media circuses, and some near misses by legitimate researchers, a team of South Korean researchers reports the production of cloned human embryos. The findings, were released Wednesday (Science, DOI:10.1126 /science.1094515, February 12, 2004).Wook Suk Hwang and Shin Yong Moon of Seoul National University used somatic cell nuclear transfer to produce 30 human blastocysts and a single embryonic stem cell line; SCNT-hES-1. Using 242 oocytes and cumulus cells from 16 unpaid donors, the group achieved a cloning efficiency of 19 to 29%, on par with that seen in cattle (25%) and pigs (26%).
Human embryos cloned
Chinese Cloning Control RequiredTuesday 16 April, 2002, 10:41 GMT 11:41 UK
Strict ethical guidelines are needed in China to calm public fears about new cell technologies such as cloning, the country's leading scientist said. Professor Ching-Li Hu, the former deputy director of the World Health Organization, was speaking at the Seventh Human Genome Meeting in Shanghai. His call follows recent reports that Chinese scientists are making fast progress in these research fields. One group in the Central South University in Changsa is said to be producing human embryo clones, while another team from the Sun Yat-sen University of Medical Sciences in Guangzhou is reported to have fused human and rabbit cells to make tissues for research.
Genetically “designed” child1997
Jeffery Steinberg, MD Fertility Institutes of Los Angeles
Five "designer babies" created for stem cell harvest
Five healthy babies have been born to provide stem cells for siblings with serious non-heritable conditions.
This is the first time "savoir siblings" have been created to treat children whose condition is not genetic, says the medical team.The five babies were born after a technique called preimplantation genetic diagnosis (PGD) was used to test embryos for a tissue type match to the ailing siblings, reports the team, led by Anver Kuliev at the Reproductive Genetics Institute in Chicago, US.The aim in these cases was to provide stem cells for transplantation to children who are suffering from leukaemia 'Unlawful and unethical' However, the use of this technology to provide a "designer baby" to treat an ill sibling is highly controversial.A UK couple involved in this
1. Verlinsky Y, Rechitsky S, Sharapova T, Morris R, Taranissi M and Kuliev A. Preimplantation HLA Testing. JAMA (2004) 29: 2079
Preimplantation Genetic ScreeningGeneral Science: May 13, 2006
A British woman has become the first in the country to conceive a "designer baby" selected specifically to avoid an inherited cancer,
The woman, who was not identified, used controversial genetic screening technology to ensure she does not pass on to her child the condition retinoblastoma, an hereditary form of eye cancer from which she suffers. Doctors tested embryos created by the woman and her partner using in-vitro fertilisation (IVF) methods for the cancer gene. Only unaffected embryos were implanted in her womb, the newspaper said. It suggested the woman's pregnancy would increase controversy over the procedure -- pre-implantation genetic diagnosis (PGD) -- because critics say it involves destroying otherwise healthy embryos whose conditions are treatable.
Gregory Stock
Science Vol 315: 1723-25, Mar 2007
Emergence of Novel Color Vision in Mice Engineered to Express Human Cone Photo-pigment
Changes in the genes encoding sensory recptor proteins are an essential step in
the evolution of new sensory capacities“new sensory capacities" . In primates, tri-chromatic color vision evolved aftre changes in x chromosome linked photopigment genes. Heterogous mouse females human L pigments showed enhanced long-wavelength sensitivity and chromatic discrimination. An inherent plasticity in the mammalian visual system thus permits emergence
whose retinas contained both mouse pigment andhuman L pigments
26 July 2007 Womb-on-a-chip may boost IVF successesLinda Geddes Teruo Fujii of the University of Tokyo in Japan and his colleagues are building a microfluidic chip to nurture the first stages of pregnancy. They hope, eventually, to create a fully automated artificial uterus in which egg and sperm are fed in at one end and an early embryo comes out the other, ready for implanting in a real mother. They say using such a device could improve the success rate of IVF."While there have been many advances in the production of in vitro embryos, these embryos are still sub-optimal [compared] to their in vivo counterparts," says Matt Wheeler of the University of Illinois in Urbana-Champaign who is also working on automated IVF systems. One reason for this is that during IVF, eggs or embryos are often moved or washed with culture fluid, causing changes in temperature and pH, he says.To tackle these problems, Fujii's team has created a "lab on a chip" that is 2 millimetres across and 0.5 millimetres high, in which up to 20 eggs can be fertilised and then grown until they are ready for implantation. Endometrial cells, which line real wombs, are also grown in the device, so that the chemicals they produce can reach the embryos help them grow. "We are providing embryos (cont. p28)
Can conception, the most intimate of human
experiences, be automated?
From the movie MATRIX RELOADED New Line Cinema
Embryo-on-a-chip
Extending Longevity
A strain of mice that have lived . . .
. . . more than three normal lifespans
Should humans live 200 years?
Life extension
Life extension consists of attempts to extend human life beyond the natural lifespan. So far none has been proven successful in humans. Several aging mechanisms are known, and anti-aging therapies aim to correct one or more of these: Dr. Leonard Hayflick discovered that mammalian cells divide only a fixed number of times. This "Hayflick limit" was later proven to be caused by telomeres on the ends of chromosomes that shorten with each cell-division. When the telomeres are gone, the DNA can no longer be copied, and cell division ceases. In 2001, experimenters at Geron Corp. lengthened the telomeres of senescent mammalian cells by introducing telomerase to them. They then became youthful cells. Sex and some stem cells regenerate the telomeres by two mechanisms: Telomerase, and ALT (alternative lengthening of telomeres). At least one form of progeria (atypical accelerated aging) is caused by premature telomeric shortening. In 2001, research showed that naturally occurring stem cells must sometimes extend their telomeres, because some stem cells in middle-aged humans had anomalously long telomeres.
April 14, 2004
CAN I REPLACE MY
B O D Y ?
If I replace 95% of my body . . .
. . . Am I still “human”?
Artificial organs
Smart Prostheses
Genetic engineering
Regeneration
Should there be replacement “parts” for astronauts?
Will Machines become “smarter than humans?
ROBOTHans Moravec
Ray Kurzweil
Humans vs Machine
Humans 4.0X10 19 cpsRed Storm 3.5X10 15 cps
Moore’ s Law “computer power doubles every 18 months”
Do the Math !!
Who is smarter now??
The Age of
Spiritual
Machines
WHEN COMPUTERS EXCEEDHUMAN INTELLIGENCE
Should astronauts be provided with super-intelligent systems*
* HAL of “2001: A Space Odeyssey
The new face of “Hal” – emotional and affective robotics
Courtesy David Hanson, Hanson Robotics, Austin, TX
Moral and Ethical Issues Raised by Technological Successwill take DECADES of debate
Summary of Examples Should we do research in areas we may not be able to control? (eg, genetics, cloning, nanobots, intelligent machines?)
Will prolonging life with technology result in more disease in the overall population
Can we change medicine from treatment to prevention of disease
In defeating diseases, will technology change a human into a combination of man and machine - what does it mean to be “human”
How will we decide who gets the technology, especially in 3rd WorldSATAVA 7 July, 1999DARPA
6
For the first time in history,
there walks upon this planet,
a species so powerful,
that it can control its own evolution,
at its own time of choosing …
… homo sapiens.
Who will be the next “created” species?
The Ultimate Ethical Question?
Do Robots Dream ?http://depts.washington.edu/biointel
Fluorescent antibodies (GFP and anti-tumor) – rat model
Whole body visualization
Monitoring
Simulataneous multifunctional –6 different fluorophores in a cell
Roger Tsien, UC-San Diego, La Jolla, CA 2006
Monitoring
Disruptive Visions
http://depts.washington.edu/biointel
“The Future is not what it used to be !”
- Yogi Berra
. . . is the creation of a functional biological substitute using living cells and a matrix to maintain, improve or restore damage to tissues and organs
Tissue Engineering
Atala, A. Engineering tissues, organs and cells. 2007 J Tissue Eng Regen Med 1: 83-96
