Области применения генной терапии
В настоящее время более 4500 заболеваний классифицированы как генетические. Только небольшая часть из них картирована (полностью изучена), а еще для меньшей части установлен биохимический механизм, с помощью которого ген осуществляет свою функцию.
Рецессивные генетические заболевания, такие, как муковисцидоз и недостаточность аденозиндезаминазы, проявляются в том случае, если повреждены оба гена. В таких доминантных аутосомных заболеваниях, как болезнь Хантингтона, эффект больного гена проявляется, даже если другой здоров. Наконец, заболевания, сцепленные с Х-хромосомой, проявляются у мужчин, тогда как женщины являются носителями поврежденного гена. Генная терапия может применяться как для монофакторных (вызванных одним геном), так и для полифакторных вследствие вовлеченности нескольких генов) заболеваний.
В соответствии с результатами современных исследований установлено, что наследственных заболеваний гораздо больше, чем было принято считать ранее (артериальная гипертензия, сахарный диабет, психические расстройства, некоторые виды рака). Даже предрасположенность к некоторым инфекционным заболеваниям обусловлена генетически.
Несмотря на сравнительно молодой «возраст» генной терапии, имеются уже конкретные практические результаты. Например, достигнута высокая клиническая эффективность лечения наследственного иммунодефицита (недостаточности аденозиндезаминазы), при котором обычные методы лечении были не эффективны, а больные — обречены.
Стратегии генной терапии можно разделить на три крупных блока:
· клетки потеряли функцию какого-либо гена. Тогда в клетку организма, которая страдает от потери этой функции, необходимо доставить ген, способный обеспечивать недостающую функцию. Это направление применяется при рецессивных наследственных заболеваниях;
· подавление избыточной функции, несвойственной для нормальной клетки (при инфекциях или опухолевых трансформациях);
· модификация генетической информации для достижения лечебного эффекта.
Например, усиление ответа иммунной системы при раке.
Генетическая информация вводится в организм пациента двумя способами. В одном случае (ex vivo генная терапия) клетки одного организма после введения им необходимой генетической информации вводятся обратно. Иммунная система организма не отторгает собственные клетки, и после введения они самостоятельно синтезируют необходимое вещество. Другой подход (in vivo генная терапия) состоит в непосредственной доставке генов в организм.
XI. Talking points:
1. Diseases of genetic origin.
2. Gene therapy as a technique for correcting defective genes.
Drawbacks of gene therapy
Unit 7
Bioengineering
Biomedical engineering (BME) is the application of engineering principles and techniques to the medical field. It combines the mechanical and mathematical expertise of engineering with the medical expertise of physicians to help improve patient health care and the quality of life of healthy individuals. As a relatively new discipline, much of the work in biomedical engineering consists of research and development, covering an array of fields: bioinformatics, medical imaging, image processing, physiological signal processing, biomechanics, biomaterials and bioengineering, systems analysis, 3-D modeling, etc. Examples of concrete applications of biomedical engineering are the development and manufacture of biocompatible prostheses, medical devices, diagnostic devices and imaging equipment such as MRIs and EEGs, and pharmaceutical drugs.
Generally, bioengineering may deal with either the medical or the agricultural fields. Because other engineering disciplines overlap bioengineering living organisms (e.g., prosthetics in mechanical engineering), the term can be applied more broadly to include food engineering and biotechnology. Biological engineering is called Bioengineering by some colleges and Biomedical engineering is called Bioengineering by others, and is a rapidly developing field with fluid categorization.
Biological engineers are similar to biologists in that they study living organisms. They are engineers because they have a practical design aim in mind — they use research to create usable tangible products. In general, biological engineers attempt to 1) mimic biological systems in order to create products or 2) modify and control biological systems so that they can replace, augment, or sustain chemical and mechanical processes.
Biomedical Engineering Training
An increasing number of universities with an engineering faculty now have a biomedical engineering program or department from the undergraduate to the doctoral level. Traditionally, biomedical engineering has been an interdisciplinary field to specialize in after completing an undergraduate degree in a more traditional discipline of engineering or science, the reason for this being the requirement for biomedical engineers to be equally knowledgeable in engineering and the biological sciences. However undergraduate programs of study combining these two fields of knowledge are becoming more widespread. As such, many students also pursue an undergraduate degree in biomedical engineering as a foundation for a continuing education in medical school.
A Biomedical Equipment Technician or BMET is a vital component of the healthcare delivery system. Employed primarily by hospitals, BMETs are the people responsible for maintaining a facility's medical equipment.
Job Responsibilities
BMETs work on many different types of equipment, depending on their facility. Typically, it will include such devices as ECG monitors, blood pressure monitors, telemetry systems, infusion pumps, ventilators or defibrillators. Some BMETs may choose to obtain specific training in order to specialize, for example, in radiology or laboratory equipment. Medical device manufacturers are required to adhere to stringent medical vilely standards such as EN 60601-1, and BMETs should be familiar with such standards. While a good portion of time can be spent on scheduled or preventive maintenance (PMs) and corrective maintenance (repairs), a BMET develops other skills with experience. A BMET may conduct product evaluations and make purchasing recommendations, install new equipment, provide in-service education, coordinate service contracts, manage assets, and investigate device related incidents. Documentation (paperwork) is an integeral part of the BMET experience.
Education
Most entry level BMETs enter into t he Held with a 2-year associate’s degree in biomedical equipment technology, while others receive military training. Practical experience is gained through internships. Continuing education in the form of service schools is typically provided by device manufacturers.
Employment
BMETs typically work in the hospital's Biomedical or Clinical Engineering Department, but can also find employment with equipment manufacturers or third-party service organizations.
A Medical Technologist (MT) is an Allied Health Professional who does clinical laboratory diagnostic analysis on human blood, urine, body fluids, and other specimens such as stool and sputum, in addition to performing other types of medical testing. A Medical Technologist can also be referred to as a Clinical Laboratory Scientist (CLS), Clinical Laboratory Technologist (CLT), or Medical Laboratory Technologist (MT), not to be confused with a Medical Laboratory Technician (MLT). Medical Technologists must hold a four year bachelor’s degree with a major in Medical Technology (Clinical Laboratory Science) or a four year degree in a life science, in which case certification from an accredited training program is also required.
The Medical Technologist’s Role in the Healthcare Process A Med Tech does not only spend time analyzing patient specimens, but also interacting with other healthcare professionals such as nurses. Often, the Med Tech’s role is to strictly enforce rules, regulations, policy, and guidelines. However, all of these policies are designed as redundant fail safe systems to protect the patient’s health. Some examples are reading aloud patient’s names, medical record numbers, or birthdates to ensure patient identification.
Medical Technologist (MT) vs Medical Laboratory Technician (MET) One source of confusion regarding the role of the Med Tech is the abundance of titles given to people in this profession. Besides being called Clinical Lab Scientist, Clinical Lab Technologist, and Medical Technologist, they are also referred to as «Lab Techs» or «Med Techs.» This shorthand term has been deemed appropriate and acceptable by all healthcare employees, including Medical Technologists. However, the term Med Tech is the major contributing factor to much confusion in the medical field. There are many «Techs» in a hospital environment, these being Pharmacy Techs, Respiratory Techs, and X-ray Techs. In these instances «tech» usually refers to a technician. While many would see this as semantics and would assume that the terms technician and technologist can be used interchangeably, there is a major dinstinction between a technician and a technologist. A technician generally holds a two year associates degree, has completed a certified training program, or less. A technologist holds a four year university degree and has been certified by a national credentialing agency. In the laboratory medicine field of healthcare, the Medical Laboratory Technician or MLT is a career in which one has completed an associates degree program. Generally, a Medical Technologist is called a Med Tech, and a Medical Laboratory Technician is called an MLT.
The Organization of the Clinical Laboratory
A Med Tech falls into the following hierarchy of the clinical laboratory. From highest authority to lowest, the scale would be as follows: Pathologist, Pathologist Assistant, Laboratory Manager, Department Supervisor, Chief Technologist (Lead Technologist), Cytotechnologist, Medical Technologist, Histotechnologist, Medical Laboratory Technician, Lab Assistant (Lab Aide), Phlebotomist, Transcriptionist, and Specimen Processor (secretary).
The Med Techs Place in the Hospital
The face of the lab is the phlebotomist. Responsibilities for a phlebotomist include entering a patient’s room, waking the patient from sleep, identifying the patient, explaining the procedure to the patient, sticking a needle in their arm, collecting the blood properly, labelling the specimen properly, bandaging the patient, end the conversation with the patient, and move on to the next patient. However, only a few months of training is required for the phlebotomist to be certified.
Med Tech Specialty Areas
A Med Tech can become specialized in a specific area of the clinical lab through additional education in a specific subject area. Most Med Techs are skilled in all areas of the lab and are referred to as Generalists. The areas of I specialty are microbiology, immunohematology (blood bank), immunology, hematology, urinalysis, coagulation, clinical chemistry, toxicology, virology, cytology, and cytogenetics.
Exercises
A.Comprehension
I. Answer these questions.
1. What is biomedical engineering?
2. What does work in biomedical engineering consists of?
3. Where are biomedical engineers trained?
4. What do BMETs work on? Where?
5. What is the medical technologist’s role in healthcare process and place in the hospital?
6. What areas can a mod tech become specialized?
II. Define the difference between Medical Technologist (MT) and Medical Laboratory Technician (MLT).
III. Agree or disagree with the following statements.
1. Biomedical engineering combine» the mechanical and mathematical expertise of engineering with the medical expertise of physicians to help improve patient health care and the quality of life of healthy individuals.
2. Biomedical engineering is an interdisciplinary field to specialize in after finishing medical school.
3. A BMET does clinical laboratory diagnostic analysis on human blood, urine, body fluids, and other specimens sue h as stool and sputum, in addition to performing other types of medical testing.
4. A Mechanical Technologist may conduct product evaluations and make purchasing recommendations, install new equipment, provide in-service education, coordinate service contracts, manage assets, and investigate device related incidents.
5. A Medical Technologist can also be referred to as a Clinical Laboratory Scientist (CLS), Clinical Laboratory Technologist (CLT), or Medical Laboratory Technologist (MT).
6. A technologist generally holds a two year associates degree, has completed a certified training program, or less.
7. Most Med Techs are skilled in all areas of the lab and are referred to as Generalists.
IV. Summarize the text, using vocabulary from Exercise 5.
B.Vocabulary
V.Match the words in the left column with their Russian equivalents in the right column:
| 1) fluid | 1) приборы, аппараты |
| 2) imaging | 2) аппаратура, оборудование |
| 3) biocompatible | 3) приобретать опыт |
| 4) equipment | 4) протез |
| 5) overlap | 5) студент ( университета ) |
| 6) undergraduate | 6) регулярное профилактическое техническое обслуживание |
| 7) widespread | 7) интраскопия |
| 8) medical school | 8) биосовместимый |
| 9) responsible | 9) частично совпадать |
| 10) maintain | 10) изменчивый; нестабильный |
| 11) blood pressure | 11) твердо придерживаться (принципов и т. д.), соблюдать |
| 12) infusion pump | 12) кровяное давление |
| 13) internship | 13) ответственный, отвечающий (за что-либо) |
| 14) gain experience | 14) оценивать |
| 15) prosthesis | 15) внеплановое техническое обслуживание |
| 16) scheduled preventive maintenance | 16) обслуживать; содержать в исправности |
| 17) corrective maintenance | 17) высшее медицинское учебное заведение |
| 18) conduct evaluation | 18) интернатура |
| 29) install | 19) устанавливать |
| 20) in-service | 20) средства, имущество |
| 21) assets | 21) масса, множество |
| 22) integral part | 22) повышающий квалификацию |
| 23) abundance | 23) неотъемлемая часть |
| 24) devices | 24) широко распространенный |
VI. Find synonyms of these expressions among the words and word combinations in the previous exercise (left column):
1) changeable; flexible; unstable; unpredictable;
2) well-known; common; general; extensive;
3) possessions; property; resources; material goods;
4) apparatus; tools; utensils;
5) partly cover; extend beyond; overlie; lie on top;
6) great quantity; plenty;
7) set up; fix; mount; fit; settle down;
8) scholar; student; apprentice; learner;
9) keep up; sustain; retain: preserve; uphold;
10) assess; appraise; estimate; calculate.
VII. Complete the sentences with words/expressions from Exercise 5. Translate the sentences into Russian.
1. Examples of concrete applications of biomedical engineering are the development and manufacture of ……. ……., medical ……. diagnostic devices and imaging equipment and pharmaceutical drugs.
2. Because other engineering disciplines ……. bioengineering living organisms (e.g., prosthetics in mechanical engineering), the term can be applied more broadly to include food engineering and biotechnology.
3. An increasing number of universities with an engineering faculty now have a biomedical engineering program or department from the ……. to the doctoral level.
4. Employed primarily by hospitals, BMETs are the people ……. for maintaining a facility’s medical equipment.
5. Typically, types of equipment will include such devices as ECG monitors, ……. ……. monitors, telemetry systems, infusion pumps, ventilators or defibrillators.
6. While a good portion of time can be spent on ……. ……. ……. (PMs) and ……. ……. (repairs), a В MET develops other skills with experience.
7. A BMET may conduct product evaluations and make purchasing recommendations, ……. new equipment, provide ……. education, coordinate service contracts, manage assets, and investigate device-related incidents.
8. Practical experience is gained through ……. .
9. Documentation (paperwork) is an ……. ……. of the BMET experience.
10. One source of confusion regarding the role of the Med Tech is the ……. of titles given to people in this profession.