Willie, good luck in the award.

Recent studies have been focusing on looking at molecular pathogenesis
of cerebral malaria. Studies have been looking at identifying the exact
molecules involved in the interaction between plasmodium infected RBCs
and endothelial walls as well as try to indentify factors which promote
the expression of these molecules on capillaries, especially in the
brain vasculature. Mainly they have been using rat models. Willie, what
are your thoughts on this (rat model) approach to studying cell
adhesion molecules?

By the way, since we have been discussing on Ca Cx, you may be
interested to know that FDA has approved a vaccine for Ca Cx. The
vaccine is for types 6,11,16 and 18. Types 6 & 11 account for 90% of
warts and types 16 & 18 account for 70% of Ca Cx cases. Trials have
shown that the vaccine is protective against future infection but not
against current infection.

cheers

ritaki

Hi! everyone,

I would like to introduce you a certain aspect of plastic
surgery.

Our department has been treating various vascular
anomalies. We receive referrals from general surgery,
pediatrics, ENT etc. To emphasize, a general surgeon
cannot do everything-again it comes down to team surgery
and quality of outcome. According to ISSVA (International
Society for the Study of Vascular Anomalies) vascular
anomalies, are classified broadly into hemangiomas or
vascular malformations. Most hemangiomas regress except
for a few on the nose and lip region. However, the
vascular malformation needs treatment for mainly cosmetic
reasons and a few bleeding cases. They can be venous,
arterial, lymphatic or capillary type.

Imagine how scared we used to be, not to do I&D on a
vascular anomaly. Recently, the treatment of such vascular
lesions has been made easy. Sometimes last year I made a
presentation at our usual grandrounds at the medical
school about 'Our Experience With Sclerotherapy'.
Sclerotherapy is:

Safe
Simple
Saves time & money
Sterile
Scar prevent recurrence
Stops bleeding & hematoma formation

Initially, general surgeons have been using sclerotherapy
to control bleeding esophageal varices. It has then
extended to treating cutaneous lesions. It is a kind of
'Minimally Invasive Surgery'.

We use mainly absolute ethanol and polidocanol (a long
chain, synthetic alcohol) for sclerotherapy in our
patients. The few complications and the recurrences we
have seen are usually dose related. Therefore, we have
decided to construct a simple in vitro model to asses the
exact concentration, that would kill an exact number of
endothelial cells. We have also studied the effect upon
mixing of these agents with serum and whole blood and also
the morphological and molecular changes, the endothelial
cells undergo, at various concentrations.

I am glad to anounce to you, our 'premature' data was
presented (poster presentation) at an international
(ISSVA) meeting in Milano, Italy yesterday. Check this
site for the program.

http://www.studioprogress.it/html/vascularpostergiovedi.htm

Our presentation was also chosen to compete for an award.
Take note that my 'boss' (Dr Furukawa) is presenting our
data. I wish I could do it next time.

Anyway, guys wish us luck, for the award.

William




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Thanks John & Rodney,

for the discussion. I think malaria is the health problem
we should be discussing and not HIV or TB. It is a big
killer from the unborn to the aged and all those in
between. I'm not aware of any statistics now to show you
the current situation but all of you should agree with me
that in any outpatients of hospitals or clinics around PNG
70 % or more of the outpatients are malaria patients.

In any step of malaria control and treatment, it is
complex. No one knows which step is the best.

The flow of the steps may be vector control, prevention,
vaccination, treatment. For vector control ask Dr Itaki
for some infor. For prevention, it is ongoing but is it
effective (sustained)? Hope there will be a vaccine soon.
But even then what will be the coverage be like. Our
coverage is still low for those immunizable diseases and
we get out breaks from time to time.

Finally, eradication is a dream we all have. However, it
is more complex than a viral disease. But if we look at
the root of the problem and a key pathway, may be the cell
adhesion molecules.

Serious morbity (cerebral malaria, multi-organ failure
etc.) which eventually leads to mortality, is mediated
through these molecules (Infection & Immunity, June 2005,
p.3271-3277).

A Japanese friend and a malaria researcher (who is suppose
to be in PNG now) believed it might be possible that
malaria parasites may infect man without causing serious
life threatening disease. I don't know how he might do
that but he said he was working along this line. We should
all know that, not all of the parasite types causes
serious illness and mortality.

Over to you guys!

William








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Yes, Dr. Itaki this is a very interesting discovery and
also the discussion was excellent.

By the way I'm interested to read on so how do I obtain
the complete paper to the abstract?

It might also be interesting to know the actual arecoline
content of a gram of betelnut, since this is the active
substance.

To add on to Dr Itaki's discussions (since I'm actually
culturing and working with endothelial cells in vitro):

In vivo with various detrimental factors, the normal
endothelium slowly progresses to atherosclerosis.
Nowadays, a stage between normal endothelium and
atherosclerotic endothelium has been identified (J Mol
Cell cardiol 31, 61-74, 1999) and it is termed ENDOTHELIAL
DYSFUNCTION. Endothelial dysfunction is characterised
mainly by 'paradoxical vasocontstriction'.

Paradoxical vasoconstriction means substances that are
known to cause vasodilation, somehow (paradoxically)
causes vasoconstriction. These known vasodilators are
mainly substances released from autonomic & sensory
nerves;
     -Acetylcholine (ARECOLINE in betelnut)
     -Norepinephrine
     -ATP
     -Substance P etc.
Normally, the endothelium responds to the above substances
by producing vasodilators;
       -Nitric oxide (NO)
       -Prostacyclin
       -Endothelium-derived hyperpolarizing factor(s)
  These substances then relaxes the underlying smooth
muscles to vasodilate. However, in Endothelial dysfunction
and arthersclerosis, this response is lost & there is
vasoconstriction instead (ECG signs of
vasoconstriction/ischaemia in Dr Itaki's cases).

Endothelial dysfunction may be taken as an early marker
for artherosclerotic risk (Arterioscler Thromb Vasc Biol.
2003;23:168-175) Tests and biomarkers have been
identified. These together with other risk factors can
make a prediction (JAMA.2004;291:1978-1986).

Ludmer et al. was the first to describe the paradoxical
response of the endothelium to acetycholine test. The
coronary artery diameter can be compared quantitatively
before and after infusion of acetylcholine (invasive,
local, angiographic test) as a clinical test to identify
endothelial dysfuction (J AM Coll
Cardiol.1997;30:325-333).

Since the above test is invasive, In the future, in PNG,
we can test the clinical safety of systemic arecoline to
identify Endothelial dysfunction or even to test for late
atherosclerosis. We can use betelnut ('buai') but since it
is too crude with many unidentified substances. That is
why we need to know the actual content of Arecoline (may
be it is known already, any body seen a paper about it?).
PNG has a potential in leading the world in clinical
research, this is one example.

Finally, the purpose of identifying endothelial dysfuntion
is for early treatment. The response may be better here
than in late disease.

Hope you enjoyed reading this small addition to Dr Itaki's
discussion.

William


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The way I understood from the reports in the newspapers was that the
drug company `Kunming Pharmaceutical Group Ltd�f was using PNG to
trial its new product ARCO. Arco is the common name used for the tree
Pau d`arco, a large canopy tree native to the Amazon rainforest. The
bark and wood have been used for centuries as herbal medicine by
natives there. Among many actions, anti-malarial is one of its
action. I am not sure if the company isolated the active ingredient
having anti-malarial activity and manufactured it in combination with
naphloquine/arthemetehr.

My understaning is the the drug is being trialed in PNG right now, at
PMGH, St. Mary`s Hospital and in Angau in Lae.

6-8 tablets stat!!!! That is a lot of drug to take in one go.

Here some key facts about the company you might be interested to know.

KEY DATA:
Kunming Pharmaceutical Group Ltd.  Ticker: 600422
Exchanges: SHG
2005 Sales: 1,207,635,000
Currency: Chinese Renmimbi
Fiscal Year Ends: December
Share Type: A Gu
Country: China
Major Industry: Drugs, Cosmetics & Health Care
Sub Industry: Ethical Drug Manufacturers
Employees: 1,638
Market Capitalization: 1,605,125,184
Total Shares Outstanding: 408,428,800
Closely Held Shares: 242,028,800

Business Description:
Kunming Pharmaceutical Group Ltd.. The Group's principal activities
are the manufacture and sale of pharmaceutical products. Other
activities include distribution of purchased medicine from other
manufacturer. Main products include chemical synthesized medicine and
natural plants extract medicine. Operations are carried out in China.

Hi friends,

We welcom Dr Dale Frank to our group. He is currently doing his MPH in
international health in Japan.

cheers

ritaki

thanks. I am not aware of any malaria control and prevention in PNG. I mean, I know of the bet-net policy and anti-malarialas Rx for all sick child but is that all we have in PNG??? Global fund recently gave a substantial amount of money to PNG to fight malaria. I have read that most have been used to purchase mosquito-net for distribution nationwide to villages with high incidences of malaria.

 

 I think PNGIMR is soon to conduct a study on intermittent Rx with anti-malarials to the determine whether this can be used to reduce anaemia and malaria in chilren.

 

PNG is one the most malarious places in the world outside of Africa (and we have all 4 plasmodium species) yet we do not have an active sustained malaria control and prevention program. As far as I know the message has been to  use bed-nets only. What about the mosquitoes themselves?? There is no ongoing national program to control mosquitoe, both the larvae and adults.

 

Thanks John for bringing this up. I think its important and we should talk more on this.

 

cheers

 

ritaki

That is when a reasonable well researched and effective policy/protocol or prevention programme is / has been in place and currently active with reasonable outcome and the goal is around the corner. Again supported by data until objectives are achieved in an ideal scenario. In this context; eradication. In any case, there is slight variation in terms of implementation and sustainability due to many factors (because we neighter have nor live in an ideal circumstance). Time or change in time being one. Personell or change in personell (wantok, qualification, qualification OK, but out put??, position) being next and down grading or up grading of facilities which ensures sustainability is another. But the biggest is funding and change of policy.

In PNG, the last is top on the list. And for these reasons, sustainability of a program to achieve desired outcome has always been a shortfall in almost many areas of sustainable management programs (Gov.or some private) in PNG and a drive towards any determination to achive any goals. One good scenario today is our PM: Work and progress of Sir Michael Somare today may equate with almost all previous PMs and their time in office (I may be wrong but), there is sustainability in it today then the past, therefore currency is recovering.
Next : A policy called "green revolution" and just have a look at the concerned departmental head turn-overs and the ministry. That program is ditched to qualify a few failed programs due to second factor highlighted above. And so we hope, there is sustainability from the top to the very least if program/system is demonstrably effective. There is no need to change but work it up for the better.

I do not have to bore you, colleagues...cheers

JT

>>> londari2000@yahoo.co.uk 06/14/06 3:26 PM >>>
I am not opptimistic about erradication but I definetly think that control and prevention can be archived.

What do you mean by sustained prevention?

ritaki

John Tonar <John.Tonar@hnehealth.nsw.gov.au> wrote:
Dear Colleagues,

Regarding malaria:

Control, Prevention, Sustained Prevention, Eradication.

From the public health perspective, above words definitely mean different interventions.

While very good progress to date made on malaria research, vaccine trial, endothelial adhesion molecules and factors etc, I for one am always optimistic on eradication.
One of these days probably in our generation's life time, we may embark on this ambitious journey on ERADICATION OF MALARIA IN PNG...at least.

Remeber, China knew Arthemether in the 60's and have used it on malaria victims ever since, just recently doors are opened to the world. In some countries, Arthemether is restricted to certain, race, genes, background and environmental exposures, and are categorised. There are leading and misleading advices, "pros" and "cons", who to believe and who not to, interests and scavengers, poor and rich, profit and loss...now that the world is no secret any more with information freeway... we can discuss the issue in this wonderful forum (Thanks - Ritaki and the fellows in UK) , ways of eradication.

WHO has a big goal, failed to reach eradication globally, extends target...now ?

For PNG

Is there any hope in the tunnel?
Are we there yet?

Maybe, if we use this forum and discuss a particular aspect of PNG health (Clinical or Management) over a period of one month, I suppose, the particular aspect of interest could be adequately discussed and allow adequate time for anyone to contribute, research and direct sites, etc to colleagues for better understanding. We can make points and reserve the right to withdraw. For instance, in the last 3-4 weeks, most of us express our gut feelings about our health system and government priorities,the way it runs at this stage in PNG.

Cheers all...

JT







Send instant messages to your online friends http://uk.messenger.yahoo.com

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That is when a reasonable well researched and effective policy/protocol or prevention programme is / has been in place and currently active with reasonable outcome and the goal is around the corner. Again supported by data until objectives are achieved in an ideal scenario. In this context; eradication. In any case, there is slight variation in terms of implementation and sustainability due to many factors (because we neighter have nor live in an ideal circumstance). Time or change in time being one. Personell or change in personell (wantok, qualification, qualification OK, but out put??, position) being next and down grading or up grading of facilities which ensures sustainability is another. But the biggest is funding and change of policy.

In PNG, the last is top on the list. And for these reasons, sustainability of a program to achieve desired outcome has always been a shortfall in almost many areas of sustainable management programs (Gov.or some private) in PNG and a drive towards any determination to achive any goals. One good scenario today is our PM: Work and progress of Sir Michael Somare today may equate with almost all previous PMs and their time in office (I may be wrong but), there is sustainability in it today then the past, therefore currency is recovering.
Next : A policy called "green revolution" and just have a look at the concerned departmental head turn-overs and the ministry. That program is ditched to qualify a few failed programs due to second factor highlighted above. And so we hope, there is sustainability from the top to the very least if program/system is demonstrably effective. There is no need to change but work it up for the better.

I do not have to bore you, colleagues...cheers

JT

>>> londari2000@yahoo.co.uk 06/14/06 3:26 PM >>>
I am not opptimistic about erradication but I definetly think that control and prevention can be archived.

What do you mean by sustained prevention?

ritaki

John Tonar <John.Tonar@hnehealth.nsw.gov.au> wrote:
Dear Colleagues,

Regarding malaria:

Control, Prevention, Sustained Prevention, Eradication.

From the public health perspective, above words definitely mean different interventions.

While very good progress to date made on malaria research, vaccine trial, endothelial adhesion molecules and factors etc, I for one am always optimistic on eradication.
One of these days probably in our generation's life time, we may embark on this ambitious journey on ERADICATION OF MALARIA IN PNG...at least.

Remeber, China knew Arthemether in the 60's and have used it on malaria victims ever since, just recently doors are opened to the world. In some countries, Arthemether is restricted to certain, race, genes, background and environmental exposures, and are categorised. There are leading and misleading advices, "pros" and "cons", who to believe and who not to, interests and scavengers, poor and rich, profit and loss...now that the world is no secret any more with information freeway... we can discuss the issue in this wonderful forum (Thanks - Ritaki and the fellows in UK) , ways of eradication.

WHO has a big goal, failed to reach eradication globally, extends target...now ?

For PNG

Is there any hope in the tunnel?
Are we there yet?

Maybe, if we use this forum and discuss a particular aspect of PNG health (Clinical or Management) over a period of one month, I suppose, the particular aspect of interest could be adequately discussed and allow adequate time for anyone to contribute, research and direct sites, etc to colleagues for better understanding. We can make points and reserve the right to withdraw. For instance, in the last 3-4 weeks, most of us express our gut feelings about our health system and government priorities,the way it runs at this stage in PNG.

Cheers all...

JT







Send instant messages to your online friends http://uk.messenger.yahoo.com

Send instant messages to your online friends http://uk.messenger.yahoo.com

That is when a reasonable well researched and effective policy/protocol or
prevention programme is / has been in place and currently active with reasonable
outcome and the goal is around the corner.  Again supported by data until
objectives are achieved in an ideal scenario. In this context; eradication. In
any case, there is slight variation in terms of implementation and
sustainability due to many factors (because we neighter  have nor live in an
ideal circumstance). Time or change in time  being one. Personell or change in
personell (wantok, qualification, qualification OK,  but out put??, position)
being next and down grading or up grading of facilities which ensures
sustainability is another. But the biggest is funding and change of policy.

In PNG, the last is top on the list. And for these reasons, sustainability of a
program to achieve desired outcome has always been a shortfall in almost many
areas of sustainable management programs (Gov.or some private) in PNG and a 
drive towards any determination to achive any goals. One good scenario today is
our PM: Work and progress of Sir Michael Somare today may equate with almost all
previous PMs and their time in office (I may be wrong but), there is
sustainability in it today then the past, therefore currency is recovering.
Next : A policy called "green revolution" and just have a look at the concerned
departmental head turn-overs and the ministry. That program  is ditched to
qualify a few failed programs due to second factor highlighted above.  And so we
hope, there is sustainability from the top to the very least if program/system
is demonstrably effective. There is no need to change but work it up for the
better.

I do not have to bore you, colleagues...cheers

JT

>>> londari2000@... 06/14/06 3:26 PM >>>
I am not opptimistic about erradication but I definetly think that control and
prevention can be archived.

   What do you mean by sustained prevention?

   ritaki

John Tonar <John.Tonar@...> wrote:
             Dear Colleagues,

   Regarding malaria:

   Control, Prevention, Sustained Prevention, Eradication.

   From the public health perspective, above words definitely mean different
interventions.

   While very good progress to date made on malaria research, vaccine trial,
endothelial adhesion molecules  and factors etc, I for one am always optimistic
on eradication.
   One of these days probably in our generation's life time, we may embark on
this ambitious journey on ERADICATION OF MALARIA IN PNG...at least.

   Remeber,  China knew Arthemether in the 60's and have used it on malaria
victims ever since, just recently  doors are opened to the world. In some
countries, Arthemether is restricted to certain, race, genes, background and
environmental exposures, and are categorised. There are leading and misleading
advices, "pros" and "cons", who to believe and who not to, interests and
scavengers, poor and rich, profit and loss...now that the world is no secret any
more with information freeway... we can discuss the issue in this wonderful
forum (Thanks - Ritaki and the fellows in UK) , ways of eradication.

   WHO has a big goal, failed to reach eradication globally, extends target...now
?

   For PNG

   Is there any hope in the tunnel?
   Are we there yet?

   Maybe, if we use this forum and discuss a particular aspect of PNG health
(Clinical or Management)  over a period of one month, I suppose, the particular
aspect  of interest could be adequately discussed  and  allow adequate time for
anyone to contribute, research and direct sites, etc to colleagues for better
understanding. We can make points and reserve the right to withdraw. For
instance, in the last 3-4 weeks, most of us express our gut feelings about our
health system and government priorities,the way it runs at this stage in PNG.

   Cheers all...

   JT









  Send instant messages to your online friends http://uk.messenger.yahoo.com

Dear Colleagues,

 

Regarding malaria:

 

Control, Prevention, Sustained Prevention, Eradication.

 

From the public health perspective, above words definitely mean different interventions.

 

While very good progress to date made on malaria research, vaccine trial, endothelial adhesion molecules  and factors etc, I for one am always optimistic on eradication.

One of these days probably in our generation's life time, we may embark on this ambitious journey on ERADICATION OF MALARIA IN PNG...at least.

 

Remeber,  China knew Arthemether in the 60's and have used it on malaria victims ever since, just recently  doors are opened to the world. In some countries, Arthemether is restricted to certain, race, genes, background and environmental exposures, and are categorised. There are leading and misleading advices, "pros" and "cons", who to believe and who not to, interests and scavengers, poor and rich, profit and loss...now that the world is no secret any more with information freeway... we can discuss the issue in this wonderful forum (Thanks - Ritaki and the fellows in UK) , ways of eradication.

 

WHO has a big goal, failed to reach eradication globally, extends target...now ?

 

For PNG

 

Is there any hope in the tunnel?

Are we there yet?

 

Maybe, if we use this forum and discuss a particular aspect of PNG health (Clinical or Management)  over a period of one month, I suppose, the particular aspect  of interest could be adequately discussed  and  allow adequate time for anyone to contribute, research and direct sites, etc to colleagues for better understanding. We can make points and reserve the right to withdraw. For instance, in the last 3-4 weeks, most of us express our gut feelings about our health system and government priorities,the way it runs at this stage in PNG.

 

Cheers all...

 

JT

 

 

 

 

 

Send instant messages to your online friends http://uk.messenger.yahoo.com

Welcome Kinipi, where are you at the moment.  Hope to here from you soon. 

Best wishes

poyap

mol william <w_mol2003@...> wrote:

Hi! Dr Kinipi,

its been a long time since our last contact. Welcome to Dr
Itaki's PNG Drs forum. There are 2 parts to it. The one
with the -CME is for medical related topics and the one
with -general, is for other general topics.

Hope to hear from you.

William

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__________________________________________________
Do You Yahoo!?
Tired of spam? Yahoo! Mail has the best spam protection around
http://mail.yahoo.com

Hi! Dr Kinipi,

its been a long time since our last contact. Welcome to Dr
Itaki's PNG Drs forum. There are 2 parts to it. The one
with the -CME is for medical related topics and the one
with -general, is for other general topics.

Hope to hear from you.

William

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BETEL NUT CAUSES PARADOXICAL VASOCONSTRICTION IN PATIENTS WITH
CORONARY ARTERY DISEASE - AN EXCITING NEW DISCOVERY IN PAPUA NEW
GUINEA WITH IMPORTANT CLINICAL IMPLICATIONS

I.H. Kevau*, B. Miam, J. Jothimanickam, G. Urae, R. Itaki, R.R. Mari,
J. Wagiebu, A. Sengupta.

(http://www.csanz.edu.au/abstracts/47abstracts/288.htm)

Sir Buri Kidu Heart Institute, Division of Medicine, University of
Papua New Guinea, Port Moresby.

The chewing of betel nut with pepper and shell lime has been a habit
of PNG people because of its euphoric effects.  Betel nut contains an
alkaloid, Arecoline, which is a parasymphatomimetic agent similar to
Acetylcholine (Ach).  Ach causes vasodilatation in a normal coronary
artery due to the release of Endothelium Derived Relaxing Factor
(Nitric Oxide).  However, in atherosclerotic vessels, it causes
paradoxical vasoconstriction and the mechanism is thought to be a
defect in endothelial vasodilator function, causing the release of
histamine and serotonin (Ludmer et al, 1986).

The aim of this study was to determine whether betel nut causes
myocardial ischaemia in patients with positive stress test.  Eight
patients with angina pectoris and positive stress test on treadmill
were studied.  In each subject, a 12-lead ECG was performed at
baseline, every 5 minutes for 20 minutes.  Heart rate (HR), systolic
and diastolic BP were also recorded.  The ECGs were read by 2
cardiologists in a blinded manner.  Ten normal volunteers were also
studied as controls.

In the normal subjects, apart from increased HR and a variable BP
response, there were no ischaemic changes on ECG with betel nut
chewing.  In 5 out of 8 patients, the ECGs at rest were either normal
or with minor ST-T wave changes.  From 5 to 15 minutes of betel nut
chewing, there were significant ST segment depression (>2mm) similar
to the change during the stress test, indicating acute myocardial
ischaemia; the changes were gone by 20 minutes.

The results suggest that betel nut containing Arecoline causes
myocardial ischaemia in patients with coronary artery disease as
indicated by a positive stress test.  The mechanism is postulated to
be similar to Ach (Ludmer et al, 1986).  These findings may have
several clinical implications in PNG, but further studies are
required.

Send instant messages to your online friends http://uk.messenger.yahoo.com

Hi! Dr Kinipi,

its been a long time since our last contact. Welcome to Dr
Itaki's PNG Drs forum. There are 2 parts to it. The one
with the -CME is for medical related topics and the one
with -general, is for other general topics.

Hope to hear from you.

William


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Yes Rodney,

it will be an interesting project regarding the effect of
malaria parasites on endothelial cells in inducing cell
adhesion molecules expression. There is huge research
going on, about cell adhesion molecules and its clinical
implications. It will be a kind of team research and I
also believe we can introduce team surgery to PNG to give
the best service to our patients.

By the way just to let you know, all our senior plastic
surgeons here, including our Professor holds a PhD the
only one with a Post Doc is my research supervisor, he is
also a senior plastic surgeon.

Until then, I'm waiting for some malaria parasites.

Hear from you later.

William

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hey Willie, great photos. Just amazing what can be
done. Talk about re-defining the definition of
impossible.

I think Dr Dube was doing some team surgery with Dr
Gende and Dr Apao. Team surgery is a concept that most
PNG surgeans will need to learn to accept. I think
most surgeon in PNG are territorial and most may not
welcome the concept. Who knows it might reveal some of
their deficiencies. Just my thoughts. Not pinpointing
any surgeons who are specialists in their own right.

Oh, willie, I will send an email to you regarding what
we discussed on malaria parasite culture and cell
adhesion molecules.

cheers

ritaki

--- John Tonar <John.Tonar@...>
wrote:

>
> Again, Dr Mol,...that is very interesting. Keep up
> those good work and experience you gain courtesy of
> Japan and your wonderful colleagues...similar
> sentiments to all others in the forum.
>
> Regards
>
> JT
>
>
>
>
>
>
>
> >>> w_mol2003@... 11/06/2006 11:52 am >>>
>
> (Apologies for previous mistakes)
>
> Team surgery is when surgeons in different fields of
> surgery combined to operate on 1 patient. This
> increases
> the endurance of the surgeon, shortens the operation
> time,
> (thus the anesthesia time) and increases the quality
> of
> the operation (or the outcome of the patient). Team
> surgery is especially, useful in major cases. The
> surgery
> is planned so that 1 surgeons does on part of the
> job,
> which he or she is most experienced with.
>
> In any major hospital around the world, here are the
> roles
> of Plastic and Reconstructive Surgery department in
> a team
> surgery:
>
> Team with:
>
> 1. General surgery
>     -Microscopic anastomosis of vessels in free
> jejunal
> transfers etc.
>      during esophageal reconstruction.
>     -large defect abdominal wounds and hernia repair
> using
> 'component
>       separation' method, local flaps or free tissue
> transfers from other
>       parts of the boddy.
>     -Breast reconstruction (usually delayed and
> using
> mainly autologus
>       abdominal fatty tissue)
>     -Microsurgery of lymph vessels to correct upper
> limb
> oedema after
>       irradiation, for breast ca
>
>
> 2. ENT
>     -Reconstruction of large upper aerodigestive
> tract
> using free
>       jejunum and omentum etc.
>     -Jaw reconstruction using free bone transfer
> after
> tumour ablative
>       surgery
>     -Facial nerve reconstruction, after parotid
> surgery
>     -cleft lip and palate management
>
> 3. Maxillofacial or Oral surgeon
>     -Reconstruction of intra-oral defect after
> cancer
> ablative surgery
>
> 4. Orthopedic surgery
>     -reconstruction of extensive limb boney or soft
> tissue
> defect after
>       trauma
>      -pressure sore reconstruction
>
> 5. Radiology (Interventional radiology)
>     -Angiogram and percutaneous and/or
> trans-catheteric
>       sclerotherapy in vascular malformations
>      -Sentinel node mapping in early stage melanoma
> patients
>
> 6. Neurosurgery
>     -Cranifacial surgery for cranisynostosis
>     -Reconstruction of large skull base defects
> after
> tumour ablative
>       surgery using pericranial flap or free tissue
> transfers
>
> 7. Pediatric surgery
>     -Repair of gastrochisis etc.
>
> 8. Gynecology
>     -Large perineal tumour ablation and
> reconstruction
>     -Sex change surgery
>
> 9. Urology
>     -Sex change surgery
>     -Microsurgical reconstruction after trauma to
> the
> penis
>
> Finally, I would like to introduce you our team of
> Plastic
> & reconstructive Surgery at the Hokkaido University
> Hospital, Sapporo, Japan.
>
> Our Professor is Yamamoto Yuhei (M.D.,PhD)
> specializing in
> microsurgery. Please check out our home page incase
> your're interested (sorry, its written in Japanese,
> but
> just have a look at the photos, it will give you
> some
> idea).
>
> Our staff
>
http://www.med.hokudai.ac.jp/~plast-w/univ/staff/staff1.html
>
>
> My photo
>
http://www.med.hokudai.ac.jp/~plast-w/univ/staff/staff2.html
>
>
> Free tissue transfer
>
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro2.html
>
>
> Microsurgery technique
>
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro3.html
>
>
> Microsurgery demo video
>
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro.html
>
>
> I hope you enjoyed reading the introduction of this
> field.
>
> William
>
> --------------------------------------
> Let's start Yahoo! Auction  -  Free Campaign Now!
> http://pr.mail.yahoo.co.jp/auction/
>
>


Send instant messages to your online friends http://uk.messenger.yahoo.com

Again, Dr Mol,...that is very interesting. Keep up those good work and
experience you gain courtesy of Japan and your wonderful colleagues...similar
sentiments to all others in the forum.

Regards

JT







>>> w_mol2003@... 11/06/2006 11:52 am >>>

(Apologies for previous mistakes)

Team surgery is when surgeons in different fields of
surgery combined to operate on 1 patient. This increases
the endurance of the surgeon, shortens the operation time,
(thus the anesthesia time) and increases the quality of
the operation (or the outcome of the patient). Team
surgery is especially, useful in major cases. The surgery
is planned so that 1 surgeons does on part of the job,
which he or she is most experienced with.

In any major hospital around the world, here are the roles
of Plastic and Reconstructive Surgery department in a team
surgery:

Team with:

1. General surgery
     -Microscopic anastomosis of vessels in free jejunal
transfers etc.
      during esophageal reconstruction.
     -large defect abdominal wounds and hernia repair using
'component
       separation' method, local flaps or free tissue
transfers from other
       parts of the boddy.
     -Breast reconstruction (usually delayed and using
mainly autologus
       abdominal fatty tissue)
     -Microsurgery of lymph vessels to correct upper limb
oedema after
       irradiation, for breast ca


2. ENT
     -Reconstruction of large upper aerodigestive tract
using free
       jejunum and omentum etc.
     -Jaw reconstruction using free bone transfer after
tumour ablative
       surgery
     -Facial nerve reconstruction, after parotid surgery
     -cleft lip and palate management

3. Maxillofacial or Oral surgeon
     -Reconstruction of intra-oral defect after cancer
ablative surgery

4. Orthopedic surgery
     -reconstruction of extensive limb boney or soft tissue
defect after
       trauma
      -pressure sore reconstruction

5. Radiology (Interventional radiology)
     -Angiogram and percutaneous and/or trans-catheteric
       sclerotherapy in vascular malformations
      -Sentinel node mapping in early stage melanoma
patients

6. Neurosurgery
     -Cranifacial surgery for cranisynostosis
     -Reconstruction of large skull base defects after
tumour ablative
       surgery using pericranial flap or free tissue
transfers

7. Pediatric surgery
     -Repair of gastrochisis etc.

8. Gynecology
     -Large perineal tumour ablation and reconstruction
     -Sex change surgery

9. Urology
     -Sex change surgery
     -Microsurgical reconstruction after trauma to the
penis

Finally, I would like to introduce you our team of Plastic
& reconstructive Surgery at the Hokkaido University
Hospital, Sapporo, Japan.

Our Professor is Yamamoto Yuhei (M.D.,PhD) specializing in
microsurgery. Please check out our home page incase
your're interested (sorry, its written in Japanese, but
just have a look at the photos, it will give you some
idea).

Our staff
http://www.med.hokudai.ac.jp/~plast-w/univ/staff/staff1.html

My photo
http://www.med.hokudai.ac.jp/~plast-w/univ/staff/staff2.html

Free tissue transfer
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro2.html

Microsurgery technique
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro3.html

Microsurgery demo video
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro.html

I hope you enjoyed reading the introduction of this field.

William

--------------------------------------
Let's start Yahoo! Auction  -  Free Campaign Now!
http://pr.mail.yahoo.co.jp/auction/

(Apologies for previous mistakes)

Team surgery is when surgeons in different fields of
surgery combined to operate on 1 patient. This increases
the endurance of the surgeon, shortens the operation time,
(thus the anesthesia time) and increases the quality of
the operation (or the outcome of the patient). Team
surgery is especially, useful in major cases. The surgery
is planned so that 1 surgeons does on part of the job,
which he or she is most experienced with.

In any major hospital around the world, here are the roles
of Plastic and Reconstructive Surgery department in a team
surgery:

Team with:

1. General surgery
     -Microscopic anastomosis of vessels in free jejunal
transfers etc.
      during esophageal reconstruction.
     -large defect abdominal wounds and hernia repair using
'component
       separation' method, local flaps or free tissue
transfers from other
       parts of the boddy.
     -Breast reconstruction (usually delayed and using
mainly autologus
       abdominal fatty tissue)
     -Microsurgery of lymph vessels to correct upper limb
oedema after
       irradiation, for breast ca


2. ENT
     -Reconstruction of large upper aerodigestive tract
using free
       jejunum and omentum etc.
     -Jaw reconstruction using free bone transfer after
tumour ablative
       surgery
     -Facial nerve reconstruction, after parotid surgery
     -cleft lip and palate management

3. Maxillofacial or Oral surgeon
     -Reconstruction of intra-oral defect after cancer
ablative surgery

4. Orthopedic surgery
     -reconstruction of extensive limb boney or soft tissue
defect after
       trauma
      -pressure sore reconstruction

5. Radiology (Interventional radiology)
     -Angiogram and percutaneous and/or trans-catheteric
       sclerotherapy in vascular malformations
      -Sentinel node mapping in early stage melanoma
patients

6. Neurosurgery
     -Cranifacial surgery for cranisynostosis
     -Reconstruction of large skull base defects after
tumour ablative
       surgery using pericranial flap or free tissue
transfers

7. Pediatric surgery
     -Repair of gastrochisis etc.

8. Gynecology
     -Large perineal tumour ablation and reconstruction
     -Sex change surgery

9. Urology
     -Sex change surgery
     -Microsurgical reconstruction after trauma to the
penis

Finally, I would like to introduce you our team of Plastic
& reconstructive Surgery at the Hokkaido University
Hospital, Sapporo, Japan.

Our Professor is Yamamoto Yuhei (M.D.,PhD) specializing in
microsurgery. Please check out our home page incase
your're interested (sorry, its written in Japanese, but
just have a look at the photos, it will give you some
idea).

Our staff
http://www.med.hokudai.ac.jp/~plast-w/univ/staff/staff1.html

My photo
http://www.med.hokudai.ac.jp/~plast-w/univ/staff/staff2.html

Free tissue transfer
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro2.html

Microsurgery technique
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro3.html

Microsurgery demo video
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro.html

I hope you enjoyed reading the introduction of this field.

William

--------------------------------------
Let's start Yahoo! Auction  -  Free Campaign Now!
http://pr.mail.yahoo.co.jp/auction/

Team surgery is when surgeons in different fields of
surgery combined to operate on 1 patient. This increases
the endurance of the surgeon, shortens the operation time,
(thus the anesthesia time) and increases the quality of
the operation (or the outcome of the patient). Team
surgery is especially, useful in major cases. The surgery
is planned so that 1 surgeons does on part of the job,
which he or she is most experienced with.

In any major hospital around the world, here are the roles
of Plastic and Reconstructive Surgery department in a team
surgery:

Team with:

1. General surgery
     -Microscopic anastomosis of vessels in free jejunal
transfers etc.
      during esophageal reconstruction.
     -large defect abdominal wounds and hernia repair using
'component
       separation' method, local flaps or free tissue
transfers from other
       parts of the boddy.
     -Breast reconstruction (usually delayed and using
mainly autologus
       abdominal fatty tissue)
     -Microsurgery of lymph vessels to correct upper limb
oedema after
       irradiation, for breast ca


2. ENT
     -Reconstruction of large upper aerodigestive tract
using free
       jejunum and omentum etc.
     -Jaw reconstruction using free bone transfer after
tumour ablative
       surgery
     -Facial nerve reconstruction, after parotid surgery
     -cleft lip and palate management

3. Maxillofacial or Oral surgeon
     -Reconstruction of intra-oral defect after cancer
ablative surgery

4. Orthopedic surgery
     -reconstruction of extensive limb boney or soft tissue
defect after
       trauma
      -pressure sore reconstruction

5. Radiology (Interventional radiology)
     -Angiogram and percutaneous and/or trans-catheteric
       sclerotherapy in vascular malformations
      -Sentinel node mapping in early stage melanoma
patients

6. Neurosurgery
     -Cranifacial surgery for cranisynostosis
     -Reconstruction of large skull base defects after
tumour ablative
       surgery using pericranial flap or free tissue
transfers

7. Pediatric surgery
     -Repair of gastrochisis etc.

8. Gynecology
     -Large perineal tumour ablation and reconstruction
     -Sex change surgery

9. Urology
     -Sex change surgery
     -Microsurgical reconstruction after trauma to the
penis

Finally, I would like to introduce you our team of Plastic
& reconstructive Surgery at the Hokkaido University
Hospital, Sapporo, Japan.

Our Professor is Yamamoto Yuhei (M.D.,PhD) specializing in
microsurgery. Please check out our home page incase
your're interested (sorry, its written in Japanese, but
just have a look at the photos, it will give you some
idea).

Our staff
http://www.med.hokudai.ac.jp/~plast-w/univ/staff/staff1.html

My photo
http://www.med.hokudai.ac.jp/~plast-w/univ/staff/staff2.html

Free tissue transfer
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro2.html

Microsurgery technique
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro3.html

Microsurgery demo video
http://www.med.hokudai.ac.jp/~plast-w/univ/lecture/micro/micro.html

I hope you enjoyed reading the introduction of this field.

William










--------------------------------------
Let's start Yahoo! Auction  -  Free Campaign Now!
http://pr.mail.yahoo.co.jp/auction/

--- John Tonar <John.Tonar@...> ¤«¤é¤Î
¥á¥Ã¥»¡¼¥¸¡§
> I like this discussion, Bill and encourage more of
> such.
>
> Thanks
>
> JT
>
>
> >>> w_mol2003@... 06/11/06 4:20 am >>>
>
> The in vivo condition is complex because of the
> interplay
> of multiple variables in maintaing the homeostasis
> of an
> organism.
>
> Nowadays with advance in technology, variou growth
> factors
> has been isolated (VEGF etc.) and combined
> specifically to
> sustain growth of cells in vitro. In our lab we have
> been
> growing fibroblasts, keratinocytes, melanoma cell
> lines
> and HUVECs (Human Umbilical Vein Endothelial Cells)
> and
> subjected them to various experimental conditions.
> With
> the in vitro condition, the experimenter is in
> control.
> You can precisely monitor and measure cell growth as
> well
> as cell death and you know the exact amount of
> experimental substance you add to the cells. Total
> RNA and
> gene analysis is done much easier then with an whole
> tissue.
>
> Individual cells has been grown successfully, now
> coming
> to the subject of tissue culture and engineering,
> especially artificial skin, how far are we?
> Actually,
> Kyoto University, is the leading research center in
> Japan
> for artificial skin and tissue engineering.
>
> As we all know, the skin is the largest organ in our
> body
> and it is complex and not easy to produce in vitro.
> The
> skin has an upper epidermal layer composed of
> keratin,
> keratinocytes, basal cell layer and basal membrane.
> The
> lower dermal layer has fibroblasts within its
> extracellular matrix, fat cells, blood vessels, hair
> follicles, sweat glands and nerve.
>
> Types of Artificial Skin
> 1. Dermal Type (No epidermis, top temporary cover
> with
> silicone or
>     other dressing)
>     a, Acellular matrix only (Collagen, hyaluronic
> acid
> etc.)
>     b, Matrix and cells (Collagen & fibroblasts
> mainly)
> -Here, after blood vessel infiltration and formation
> into
> the matrix, usual skin graft (STSG or FTSG) is done,
> sometimes cultured keratinocytes is grafted. For
> example
> INTEGRA (consist of upper silicone film and a lower
> layer
> of porous cross-linked collagen and
> chondroitin-6-sulphate
> without any cells) has been clinically used in burn
> patients, in Europe.
>
> 2. Epidermal type
>     -Cultured Keratinocytes on a thin collagen or
> other
> material film
>
> 3. Combined Dermal and Epidermal Type
>      Acellular matrix with or without cells and top
> keratinocyte layer
>      (delay in blood vessel infiltration may cause
> death
> of the top
>       keratinocyte layer)
>
> Problems of Artificial Skin:
>
> 1. Infection (eg. viral infection of cultured cells)
> 2. Expensive (cell culture technology)
> 3. Time consuming (to expand autologus fibroblast,
> it may
> take up to a month or more, using allograft has
> rejection
> problem and cell banking of all normal individuals
> may be
> extremely expensive)
> 4. Difficult process of cell culture
> 5. Shortening of telomere (Counter CM et al.)
> (continuous
> culturing of cells in vitro shortens telomere and
> short
> telomere means cells are old so once grafted and
> they
> don't last long in vivo)
> 6. Altered in vitro enironment changes cell
> characteristics-Hox genes are not preserved
> (Santa-Olalla
> J et al.) (this means even autologus cells may
> change and
> become allogenic after culture in vitro)
> 7. Incomplete take or incorporation even for auto
> transplants (Teepe RT et al.) (grafted cultured
> keratinocyte looks very abnormal, compared to
> normal)
> 8. Never replaces but stimulates only (Tanaka M et
> al.)
> (grafted cultured cells doesn't replace normal cells
> in
> vivo but stimulates them to grow in and eventually
> replace
> them)
> 9. Rejection and Allergies (sometimes synthetic
> materials
> eg. silicone and bovine collagen is used)
>
> Is there another hope then?
>
> Another concept could be to stimulate cells in vivo
> to
> grow & migrate faster with growth factors. Already
> bFGF
> (basic fibroblast growth factor) has been used in
> stimulating and quickening wound healing. It comes
> in a
> spray form so after debriding and cleaning the
> wound, you
> simply spray it onto the wound surface. It enhances
> fibroblast migration to speed up the process of
> granulation tissue formation.
>
> Another concept is the application of stem cells.
> With
> world wide ethical dispute into embryonic stem
> cells,
> scientists have looked into the adult body in search
> for
> autologus stem cells. The adult body has stem cells
> which
> continually replaces worn out cells:
> 1. Basal cells in basal layer of epidermis and hair
> follicles and mucous membranes
> 2. Bone marrow hemopoetic and mesenchymal stem
> cells.
>
> The bone marrow messenchymal stem cell is like a
> fibroblast of the bone marrow. Its multipotent
> abilities
> has been discovered and applied. Physiologically, it
> migrates to wound sites and helps in tissue
> regeneration.
> When applied to wounds they form blood vessels.
> However in
> vitro experiments proves that they can form a wide
> range
> of tissues eg. nerve cells, cartilage, muscle etc.
> with
> various combination of growth and differentiation
> factors.
>
> After application or grafting, It is difficult to
> trace
> the in vivo fate of these cells. Therefore, there
> are some
> disputes. The in vivo fate of these cells are
> determined
> by 2 processes:
> 1. Cell fusion (the stem cell undergo cell fusion
> with the
> nearby adult cells and attains that cells
> characteristics)
> 2. Transdifferentiation (Without cell fusion, upon
> contact
> with growth factors and extracellular matrix of the
> surrounding tissue, it differentiates accordingly.
>
> The current trend in research now is:
> 1. to prove that the transfered stem cells survives
> and
> differentiated into the desired adult cells and is
> functioning normally
> 2. Techniques of transfering or grafting to enhance
> maximum and quick tissue regeneration
>
=== message truncated ===

--------------------------------------
Let's start Yahoo! Auction  -  Free Campaign Now!
http://pr.mail.yahoo.co.jp/auction/

I like this discussion, Bill and encourage more of such.

Thanks

JT


>>> w_mol2003@... 06/11/06 4:20 am >>>

The in vivo condition is complex because of the interplay
of multiple variables in maintaing the homeostasis of an
organism.

Nowadays with advance in technology, variou growth factors
has been isolated (VEGF etc.) and combined specifically to
sustain growth of cells in vitro. In our lab we have been
growing fibroblasts, keratinocytes, melanoma cell lines
and HUVECs (Human Umbilical Vein Endothelial Cells) and
subjected them to various experimental conditions. With
the in vitro condition, the experimenter is in control.
You can precisely monitor and measure cell growth as well
as cell death and you know the exact amount of
experimental substance you add to the cells. Total RNA and
gene analysis is done much easier then with an whole
tissue.

Individual cells has been grown successfully, now coming
to the subject of tissue culture and engineering,
especially artificial skin, how far are we? Actually,
Kyoto University, is the leading research center in Japan
for artificial skin and tissue engineering.

As we all know, the skin is the largest organ in our body
and it is complex and not easy to produce in vitro. The
skin has an upper epidermal layer composed of keratin,
keratinocytes, basal cell layer and basal membrane. The
lower dermal layer has fibroblasts within its
extracellular matrix, fat cells, blood vessels, hair
follicles, sweat glands and nerve.

Types of Artificial Skin
1. Dermal Type (No epidermis, top temporary cover with
silicone or
     other dressing)
     a, Acellular matrix only (Collagen, hyaluronic acid
etc.)
     b, Matrix and cells (Collagen & fibroblasts mainly)
-Here, after blood vessel infiltration and formation into
the matrix, usual skin graft (STSG or FTSG) is done,
sometimes cultured keratinocytes is grafted. For example
INTEGRA (consist of upper silicone film and a lower layer
of porous cross-linked collagen and chondroitin-6-sulphate
without any cells) has been clinically used in burn
patients, in Europe.

2. Epidermal type
     -Cultured Keratinocytes on a thin collagen or other
material film

3. Combined Dermal and Epidermal Type
      Acellular matrix with or without cells and top
keratinocyte layer
      (delay in blood vessel infiltration may cause death
of the top
       keratinocyte layer)

Problems of Artificial Skin:

1. Infection (eg. viral infection of cultured cells)
2. Expensive (cell culture technology)
3. Time consuming (to expand autologus fibroblast, it may
take up to a month or more, using allograft has rejection
problem and cell banking of all normal individuals may be
extremely expensive)
4. Difficult process of cell culture
5. Shortening of telomere (Counter CM et al.) (continuous
culturing of cells in vitro shortens telomere and short
telomere means cells are old so once grafted and they
don't last long in vivo)
6. Altered in vitro enironment changes cell
characteristics-Hox genes are not preserved (Santa-Olalla
J et al.) (this means even autologus cells may change and
become allogenic after culture in vitro)
7. Incomplete take or incorporation even for auto
transplants (Teepe RT et al.) (grafted cultured
keratinocyte looks very abnormal, compared to normal)
8. Never replaces but stimulates only (Tanaka M et al.)
(grafted cultured cells doesn't replace normal cells in
vivo but stimulates them to grow in and eventually replace
them)
9. Rejection and Allergies (sometimes synthetic materials
eg. silicone and bovine collagen is used)

Is there another hope then?

Another concept could be to stimulate cells in vivo to
grow & migrate faster with growth factors. Already bFGF
(basic fibroblast growth factor) has been used in
stimulating and quickening wound healing. It comes in a
spray form so after debriding and cleaning the wound, you
simply spray it onto the wound surface. It enhances
fibroblast migration to speed up the process of
granulation tissue formation.

Another concept is the application of stem cells. With
world wide ethical dispute into embryonic stem cells,
scientists have looked into the adult body in search for
autologus stem cells. The adult body has stem cells which
continually replaces worn out cells:
1. Basal cells in basal layer of epidermis and hair
follicles and mucous membranes
2. Bone marrow hemopoetic and mesenchymal stem cells.

The bone marrow messenchymal stem cell is like a
fibroblast of the bone marrow. Its multipotent abilities
has been discovered and applied. Physiologically, it
migrates to wound sites and helps in tissue regeneration.
When applied to wounds they form blood vessels. However in
vitro experiments proves that they can form a wide range
of tissues eg. nerve cells, cartilage, muscle etc. with
various combination of growth and differentiation factors.

After application or grafting, It is difficult to trace
the in vivo fate of these cells. Therefore, there are some
disputes. The in vivo fate of these cells are determined
by 2 processes:
1. Cell fusion (the stem cell undergo cell fusion with the
nearby adult cells and attains that cells characteristics)
2. Transdifferentiation (Without cell fusion, upon contact
with growth factors and extracellular matrix of the
surrounding tissue, it differentiates accordingly.

The current trend in research now is:
1. to prove that the transfered stem cells survives and
differentiated into the desired adult cells and is
functioning normally
2. Techniques of transfering or grafting to enhance
maximum and quick tissue regeneration

Until then, I hope this summary has shed some light.

William
(Sapporo, Japan)






--------------------------------------
Let's start Yahoo! Auction  -  Free Campaign Now!
http://pr.mail.yahoo.co.jp/auction/

The in vivo condition is complex because of the interplay
of multiple variables in maintaing the homeostasis of an
organism.

Nowadays with advance in technology, variou growth factors
has been isolated (VEGF etc.) and combined specifically to
sustain growth of cells in vitro. In our lab we have been
growing fibroblasts, keratinocytes, melanoma cell lines
and HUVECs (Human Umbilical Vein Endothelial Cells) and
subjected them to various experimental conditions. With
the in vitro condition, the experimenter is in control.
You can precisely monitor and measure cell growth as well
as cell death and you know the exact amount of
experimental substance you add to the cells. Total RNA and
gene analysis is done much easier then with an whole
tissue.

Individual cells has been grown successfully, now coming
to the subject of tissue culture and engineering,
especially artificial skin, how far are we? Actually,
Kyoto University, is the leading research center in Japan
for artificial skin and tissue engineering.

As we all know, the skin is the largest organ in our body
and it is complex and not easy to produce in vitro. The
skin has an upper epidermal layer composed of keratin,
keratinocytes, basal cell layer and basal membrane. The
lower dermal layer has fibroblasts within its
extracellular matrix, fat cells, blood vessels, hair
follicles, sweat glands and nerve.

Types of Artificial Skin
1. Dermal Type (No epidermis, top temporary cover with
silicone or
     other dressing)
     a, Acellular matrix only (Collagen, hyaluronic acid
etc.)
     b, Matrix and cells (Collagen & fibroblasts mainly)
-Here, after blood vessel infiltration and formation into
the matrix, usual skin graft (STSG or FTSG) is done,
sometimes cultured keratinocytes is grafted. For example
INTEGRA (consist of upper silicone film and a lower layer
of porous cross-linked collagen and chondroitin-6-sulphate
without any cells) has been clinically used in burn
patients, in Europe.

2. Epidermal type
     -Cultured Keratinocytes on a thin collagen or other
material film

3. Combined Dermal and Epidermal Type
      Acellular matrix with or without cells and top
keratinocyte layer
      (delay in blood vessel infiltration may cause death
of the top
       keratinocyte layer)

Problems of Artificial Skin:

1. Infection (eg. viral infection of cultured cells)
2. Expensive (cell culture technology)
3. Time consuming (to expand autologus fibroblast, it may
take up to a month or more, using allograft has rejection
problem and cell banking of all normal individuals may be
extremely expensive)
4. Difficult process of cell culture
5. Shortening of telomere (Counter CM et al.) (continuous
culturing of cells in vitro shortens telomere and short
telomere means cells are old so once grafted and they
don't last long in vivo)
6. Altered in vitro enironment changes cell
characteristics-Hox genes are not preserved (Santa-Olalla
J et al.) (this means even autologus cells may change and
become allogenic after culture in vitro)
7. Incomplete take or incorporation even for auto
transplants (Teepe RT et al.) (grafted cultured
keratinocyte looks very abnormal, compared to normal)
8. Never replaces but stimulates only (Tanaka M et al.)
(grafted cultured cells doesn't replace normal cells in
vivo but stimulates them to grow in and eventually replace
them)
9. Rejection and Allergies (sometimes synthetic materials
eg. silicone and bovine collagen is used)

Is there another hope then?

Another concept could be to stimulate cells in vivo to
grow & migrate faster with growth factors. Already bFGF
(basic fibroblast growth factor) has been used in
stimulating and quickening wound healing. It comes in a
spray form so after debriding and cleaning the wound, you
simply spray it onto the wound surface. It enhances
fibroblast migration to speed up the process of
granulation tissue formation.

Another concept is the application of stem cells. With
world wide ethical dispute into embryonic stem cells,
scientists have looked into the adult body in search for
autologus stem cells. The adult body has stem cells which
continually replaces worn out cells:
1. Basal cells in basal layer of epidermis and hair
follicles and mucous membranes
2. Bone marrow hemopoetic and mesenchymal stem cells.

The bone marrow messenchymal stem cell is like a
fibroblast of the bone marrow. Its multipotent abilities
has been discovered and applied. Physiologically, it
migrates to wound sites and helps in tissue regeneration.
When applied to wounds they form blood vessels. However in
vitro experiments proves that they can form a wide range
of tissues eg. nerve cells, cartilage, muscle etc. with
various combination of growth and differentiation factors.

After application or grafting, It is difficult to trace
the in vivo fate of these cells. Therefore, there are some
disputes. The in vivo fate of these cells are determined
by 2 processes:
1. Cell fusion (the stem cell undergo cell fusion with the
nearby adult cells and attains that cells characteristics)
2. Transdifferentiation (Without cell fusion, upon contact
with growth factors and extracellular matrix of the
surrounding tissue, it differentiates accordingly.

The current trend in research now is:
1. to prove that the transfered stem cells survives and
differentiated into the desired adult cells and is
functioning normally
2. Techniques of transfering or grafting to enhance
maximum and quick tissue regeneration

Until then, I hope this summary has shed some light.

William
(Sapporo, Japan)






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Hi friends,

As I mentioned in my last posting our research group submitted the
nucleotide sequences for anopheles farauti 1 from Solomon Islands and
PNG to the GeneBank data base.

We now have the accession numbers. The sequences have not been
published yet. However, the data are being process so will be
released as soon as it is ready as we did not give a release date to
GeneBank. Just some minor adjustments and will be accessable by the
public on GeneBank, NIH.

Here the accession numbers in case you might need them for your own
researches.

>                 TA1             DQ674709
>                 TA2             DQ674710
>                 TA8             DQ674711
>                 TA14            DQ674712
>                 TB6             DQ674713
>                 TB7             DQ674714
>                 TC4             DQ674715
>                 TC8             DQ674716
>                 TC9             DQ674717
>                 TD2             DQ674718
>                 TD5             DQ674719
>                 TD6             DQ674720
>                 TD7             DQ674721
>                 TF1             DQ674722
>                 T11-12          DQ674723
>                 FA6             DQ674724
>                 FA9             DQ674725
>                 FA16            DQ674726
>                 DA33            DQ674727
>                 DA34            DQ674728
>                 DB16            DQ674729
>                 DB17            DQ674730
>                 DB19            DQ674731
>                 DB27            DQ674732
>                 B8-7            DQ674733
>                 WA-8            DQ674734

cheers

ritaki

Hi friends,

In today`s world of medical research more and more researchers are
doing collaborative work. You can get more publication by doing
collaborative work.

I would therefore like to suggest that we can use this group to
discuss possible ways where we can do collaborative research in PNG.
PNG is a gold mine for any researcher and I think we can do a lot
publication because not much data is available from PNG.

To start of I would like to share with you what I am currently doing.
I am doing a lot of things actually. My research group main project
has been to identify mosquitoe sibling species transmitting malaria
in PNG using DNA based technology. We are half-way throuh it. We have
managed to sequence the CO2 region of anopheles farauti 1 in attempt
to qauantify the genetic variabilty. We are also analysing ITS2
region. The sequences for CO2 region of anopheles farauti 1 from PNG
have been submitted to the GeneBank, NIH (USA) and we are waiting for
verification and access number.

We are also doing transmission studies by looking at Circumsporozoite
antigen (CS-antigen) in anopheles species using ELISA.

I am also doing studies on larval behavior to document their
organisational behavior as a pre-requisite to developing new methods
for controlling vecotor-born diseases.I am doing studies on aedes
species (dengue vector), culex species (vector for West Nile virus,
filariasis, Japanese encephalitis and avian malaria) and anopheles
(malaria vector).

Cheers

ritaki

Thanks Rondney,

for the changes and invitation.

William

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hey Eddie na Poyap, welcome!

I am looking for suitable photo to put on the group hompage, any
suggestions?

cheers

ritaki