Monday 14 October 2013

Individual Topical Review: Cryogenics: Freezing our way to a healthier life.

Cryogenics: Freezing our way to a healthier life.

1. Executive Summary
The common misconception with cryogenics is that it is often associated with science-fiction, i.e. an astronaut waking up in space after years of cryo-sleep in his cryo-pod. While this image portrayed may be true to a certain extent, the science of cryogenics runs much deeper than that.

This paper examines the medical applications of cryogenics in various medical fields such as oncology, dermatology and surgical applications as well as its limitations and potential for further development. It also seeks to discuss its more controversial subset: Cryonics. It’s potential in prolonging lifespan, current technical limitations and the ethical debate behind the science of cryonics.

2. Background/Introduction

The use of cold for medical treatments has been around for hundreds of years, dating back to 3500 B.C. where it was used as a form of therapy (Wang, 2006). Its applications have since evolved to range from its use as a form of anaesthesia to treating of dementia to destroying cancerous tumours and keloids (dermatology). (Wang, 2006; Rubinsky, 2000; Levy, 2009; Goldenberg, 2013) Although not commonly used it is still recognized as a viable and effective form of medical treatment. And with further technological advancements that allows greater efficacy and accuracy of the treatment, it has the potential to become an extremely viable tool in the treatment of cancerous tumours

The more controversial side of cryogenics is cryonics. It is essentially the science of “freezing” and “reanimation” of dead bodies in the future with the hope that future technological and medical advancements will eventually restore the body to full health, allowing the individual greater lifespan or at least postponing death. However, science in cryonics is far from complete and scientist will have to cross numerous major hurdles before cryonics become viable. Then there is the ethical debate over “freezing” and “reanimation” in the future. Concerns over the morality and socio-economic impact of reviving someone from possibly hundreds of years ago were raised.

This paper seeks to examine the medical applications of cryogenics in various medical fields such as oncology, dermatology and surgical applications. It will also discuss the current limitations on the use of cryogenics in surgeries and potential areas of improvements. It also seeks to discuss its more controversial subset: Cryonics. It will touch on the benefits of cryonics, such as prolonging lifespan of the patient, avoiding death and also its current technical limitations and the ethical debate behind the science of cryonics.

3. Historical Perspective

3.1 Cryosurgery
The use of cryo-technology in surgery in aptly named Cryosurgery. It is the use of very low temperatures to destroy undesirable tissue, typically cancerous tumours. (Nellis, 2009)

The first recorded use of cold as a therapeutic tool was recorded in the Edwin Smith Papyrus, written at 3,500 B.C. Since then, there have been various records of its many applications. A French army surgeon during the Napoleon Wars, Baron de Larrey, used cold as a form of anaesthesia to perform painless amputation in an era where alcohol was the only other alternative. (Wang, 2006) Its use as an anaesthetic was further by physician like James Arnott in the mid-nineteenth century. (Rubinsky, 2000) In 1791, a physician Philip Pinel observed a case where a mentally ill patient was apparently cured of his deluded mental state after being exposed to cold in an attempt to escape his mental ward. Cold was also used to treat other malignancies and head injuries. In 1938, Temple Fay, a neurosurgeon, introduced whole body hypothermia to treat these ailments which resulted in a high success rate of 95.7% and low mortality rate of 11.2%. (Rubinsky, 2000)

In the mid-nineteenth century, the physician James Arnott(the same as mentioned above) discovered that cancerous tumours that are exposed to low temperatures(-12°C) are much less offensive after thawing. (Rubinsky, 2000) The effect of low freezing on cells has been studied extensively. “Cell death occurs when either very slow or very rapid cooling rates are used. Slow cooling rates lead to the formation of extracellular ice while the intracellular fluid remains, for a time, unfrozen. The difference in the osmotic pressure that results causes water flow out of the cell, leading to death by dehydration. Very rapid cooling rates are used in cryosurgery in order to cause the formation of ice crystals in the intracellular fluid, rupturing the cell walls.” (Nellis, 2009)

It has since been adapted into the field of oncology where this technique was furthered to destroy cancerous tumour tissues located near the surface of the skin and keloid scars which are benign, dermal, fibroproliferative tumours. (Nellis, 2009)

Until that point in time the use of cold in the treatment of patients were mainly focused on the physiological reaction of the human body in reaction to low temperature. Although it has been also used to treat cancerous tumours, it is mostly confined to the surface of the skin as the cold was only able to penetrate up to a depth of several millimetres due to limitations of available surgical tools.

However, this paradigm was shifted when in 1961, a neurosurgeon, Irving Cooper built the first cryosurgical probe that used liquid nitrogen as a coolant that is applicable for surgical use. (Rubinsky, 2000; Wang, 2006) This probe has allowed physicians to conduct minimally invasive surgeries to destroy undesirable tissues that would be otherwise be inaccessible to traditional cold-therapy. This has ushered in the modern era of cryosurgery.

3.2 Cryonics

In the 1960s, with the advances of cryosurgery came the advent of cryonics. It is the preservation and storage of legally dead humans using the process of vitrification in hopes that they can be revived in the future when medical advances will be able to restore their health and possibly youth.

As extremely low temperatures will damage cells tissues (refer to above), long term preservation using traditional freezing method is not viable. Instead, cryonics achieves this goal via a process called vitrification where the blood of the subject is replaced with an organ-preservation solution which will prevent organ/tissue damage during preservation. The patient is then transferred to a tank filled with liquid nitrogen for preservation. (Knight, 2008)

4. Current Situation

4.1Cryosurgery           

Procedure:
Cryosurgery is currently used as a form of minimally invasive surgical technique to remove undesirable tissues. (Rubinsky, 2000) It is a safer, less invasive and intrusive as compared to the traditional scalpel or open surgeries. In comparison between procedures such as the laparoscopic renal cryoablation (use of cryosurgical probe) against the traditional laparoscopic partial nephrectomy (use of scalpel) to remove small renal tumor, the cryoablation procedure is often associated with lesser blood loss and a shorter hospitalization period for the patient with the same rate of success. (Levy, 2010)


There is also increasing recognition for the use of cryosurgery as its benefits outweigh traditional treatments. In 1996, the use of cryoablation in the treatment of prostate cancer is traditionally seen as a last resort for patients who had failed radiation therapy. With the technological advances in the field of cryosurgery, its application have now expanded to the treatment of early stage prostate cancer with similar success rate as traditional radiotherapy but minus the complications from exposure to radiation. (Levy, 2010)

However, there are limitations to this procedure. From the report of “Current state of urological cryosurgery: prostate and kidney” by Levy, D., Avallone, A., & Jones, J. (2010), data collected indicates that the efficacy of the cryosurgical procedure is comparable to radiotherapy in the early stages of prostate cancer. In the later stages, the data skews heavily in favour of traditional radiotherapy in comparison of biochemical Disease-Free Survival (bDFS) periods and Prostate Specific Antigen (PSA) levels. This shows the procedure’s limitation in treating locally advanced disease.

Equipment:


Currently most cryosurgeries involve the use of the cryosurgical probe. However, the traditional probes were bulky and unwieldy. Also, in using liquid nitrogen as a coolant, the system’s operational period is severely limited to the supply of liquid nitrogen. Furthermore, there are various safety concerns when handling liquid nitrogen and  in using liquid nitrogen means that the operating room has to be constantly ventilated to prevent a build-up of nitrogen gas. (
Nellis, 2009)

In view of such limitations, the cryosurgical probe was revamped drastically when multi-component working fluids (i.e. mixed gas) were introduced which provided for better refrigeration capability and smaller pressure required by the probe. The result was a smaller, more portable machine that provides more cooling power, can operate indefinitely and does not require ventilation. (Nellis, 2009)


Another revolutionary advance in cryosurgery was pioneered by Onik, a radiologist, and Rubinsky, an engineer, who introduced the use of image monitoring devices such as X-ray, Magnetic Resonance Imaging (MRI) and ultrasound into cryosurgery. Such tools have provided surgeons with the ability to observe and monitor the exact rate and extent of freezing of tissue matter during surgery. (Rubinsky, 2000) Thus allowing greater surgical precision and greatly enhances patient safety during the procedure.

4.2 Cryonics

People who are involved in cryonics call themselves cryonicists. Cryonicists believe that death can be beaten using cryonics. Terminally ill patients, like cancer patients, who have ran out of options for treatment can simply freeze themselves till some point in the future where the biomedical science has advance enough to treat whatever ailments that would’ve killed them. They would simply be woken out of “suspension”, be cured of the disease and continue to live a healthy normal life. The justification here is that since the person will die anyway, cryonics offer a way, however slim, out. Providing the patient a chance for survival in the future.

Another option would be the preservation of the brain. Since it's the memories, characteristics, experiences contained inside the brain that essentially makes up the person, preserving only the brain would essentially be preserving the person’s entire conscience. Then, the cryonics patient will have to be in “suspense” until such a time when a body can be grown to transplant the patient’s brain. (Shaw, 2009)

This is accomplished through the process of vitrification (as mentioned above). With the current technological level, it is possible to preserve the body without causing much damage to the organ tissue. However, it is the “reanimation” that poses significant technical difficulties.

With the present level of technology, it is impossible “reanimate” cryonic patients without causing significant damage at a cellular level due to the side effects of cryo-preservation. To repair the damage would require advanced nano-technology and stem cell therapy that we do not yet possess. (Knight, 2008)

There are currently also ethical issues regarding cryonics. (TBA)

5. Future Considerations

5.1 Cryosurgery
Even with today’s technology, there are still limitations to the refrigeration power of cryosurgical probes. Several probes are still needed to destroy cancerous tumours of substantial size, suggesting the limitations of currents technologies. Chemical additives could be added in the procedure to further enhance the freezing process. (Nellis, 2009) It is also suggested that using computing models to optimize placement of probes could serve as a viable solution. (Levy, 2010)

Another consideration is the freezing process of the procedure. The freezing is usually confined only to around the tip of the probe with the freezing process gradually slowing as it spreads outward due to greater insulation from the frozen cells. The inability to control such process is further complicated by blood perfusion or the presence of large blood vessels near the probe. One solution suggested would be to adopt real-time computer simulations of the surgery. However that would require significant amount of computing power that we do not yet possess. (Nellis, 2009)

5.2 Cryonics
(TBA)

Conclusion
(TBA)

References
1)      Wang, H. H., Olivero, W. W., Wang, D. D., & Lanzino, G. G. (2006). Cold as a therapeutic agent. Acta Neurochirurgica, 148(5), 565-570. doi:10.1007/s00701-006-0747-z
2)      Rubinsky, B. (2000). CRYOSURGERY. Annual Review Of Biomedical Engineering, 2(1), 157.
3)      Romain, T. (2010). Extreme Life Extension: Investing in Cryonics for the Long, Long Term. Medical Anthropology, 29(2), 194-215.
4)      Doherty, D. J. (1989). An Ethical Appraisal of CRYONICS. USA Today Magazine, 117(2524), 73-74.
5)      Trembley, A. C. (1999). Cyronic Patients: Gone Today, Here (And Richer) Tomorrow. National Underwriter / Life & Health Financial Services, 103(45), 7.
6)      BARBARO, V. (2011). HEAVEN FOR ATHEISTS. Humanist, 71(4), 24-29.
7)      Knight, C. C. (2008). A science without a deadline [cryonics]. Engineering & Technology (17509637), 3(19), 28-31. doi:10.1049/et:20081903
8)      Nellis, G. (2009, March). EDITORIAL: Cryosurgery: An Emerging Application for Low-Temperature Refrigeration. HVAC&R Research. pp. 165-167.
9)      SHAW, D. (2009). CRYOETHICS: SEEKING LIFE AFTER DEATH. Bioethics, 23(9), 515-521. doi:10.1111/j.1467-8519.2009.01760.
10)  GOLDENBERG, G., & LUBER, A. J. (2013). Use of Intralesional Cryosurgery as an Innovative Therapy for Keloid Scars and a Review of Current Treatments. Journal Of Clinical & Aesthetic Dermatology, 6(7), 23-26.
11)  Levy, D., Avallone, A., & Jones, J. (2010). Current state of urological cryosurgery: prostate and kidney. BJU International,105(5), 590-600. doi:10.1111/j.1464-410X.2010.09235.x



Sunday 13 October 2013

TWC Session 7

Session 7 started off on the topic of Biobusiness and sustainability. As the biobusines advances through the years, its developments have generally been classified into 4 categories: Red (technology applied to humans), Green (technology applied to plants and animals), Blue (technology applied to marine life), White (technology with industrial application).

With the advent and improvement of agricultural technology over the years, calorie yield per acre has dramatiscally increased. My own research from worldhunger.com shows that we have plenty of food to feed everyone with at least 2,720 kcal/person/day. So why then, does the problem of hunger still persist around the world? We already have the technological know-how and the ability to feed everyone, so why do people still go hungry? The problem then is not a technological problem but a political one. I believe that it is poor governance and corrupt governance that is to blame. These governments are extractive institutions where the elite class would draw resources out from society to enrich themselves while leaving the people with little resources to purchase basic necessities. I believe that the problem of world hunger can be solved, but not with higher productivity or yield per acre but from improving governence around the world which is an admittedly much more daunting task.

Next I would like to talk about something that is not exactly related to session 7 but still related to TWC. In the previous lessons, we've discussed the importance of going green, living a sustainable lifestyle to ensure long term benefits not only for ourselves but our children as well. I believe that people of my age is one of the most well-informed generation of people there is with regards to the topic of sustainability.

We all know the theory behind the importance of sustainability but how many of us actually apply what we learn in our daily lives? Not many, I believe. But in my recent trip back to Shanghai, I’ve discovered a group of people who does: My grandparents. They were never educated on the importance of living in a sustainable manner or leaving as little carbon footprints as possible or the 3Rs but they apply these principles every day. My grandmother (age 70+) would never take a cab or my dad’s car if she could take a bus and would never take a bus if she could walk to her destination. My grandparents are the only people I've seen who would reuse an old shirt in so many ways that I can’t even begin to describe how (she once made her own mop). They are the only ones who would turn off all electrical appliances in the house when they leave and when I say all, I mean all. They would chastise me for waste any food and would rather boil in the summer heat than turn on the air-con. They are the greenest people I know.

What I find interesting about this is that the reason why they did what they did wasn't to protect the environment or leave a greener planet for me and my kids to live in. They were simply worried about their electric bill. That got me thinking. Maybe the way to teach the younger generation about sustainability is not to drill them with facts and scary, apocalyptic prophecies but start with something simple like frugality. Just my two yuan worth of thought.

Sunday 29 September 2013

TWC Sesson 6

Session 6 was focused on BioBusiness Revolution: Healthcare and Biomedical Sciences. We looked at the development of various incredibly innovative ways the bio-business have grown and are growing into over the years.

There are several interesting trends observed during the session. One such was the decline of communicable diseases and rise of chronic illness in developing countries. As medical technology improved in developed countries, problems associated with food, hygiene and mortality rate dramatically decreases. However, this has lead to its own set of problems. A little digging revealed that the chronic illnesses are given very apt names in developed countries: diseases of civilization, diseases of affluence, or Western diseases. Among the many diseases of civilization are: obesity, diabetes, cardiovascular disease among a whole laundry list of other problems typically associated with people who've eat too much or lived too long. While in developing countries, communicable diseases are still the primary problem mainly due to lack of sanitation, poor access to adequate nutrition and sub-standard medical services. Chronic illness are still a side-note as people simply didn't eat enough or lived long enough to contract them.

Another interesting issue discussed was future of medical care. There was a video showing that this is shifting toward a more personalized care system where doctors can now monitor your health 24/7, probably via microchip implants. Consultations using video conferencing technology can now allow patients to skip the hour long (a gross understatement) queues and see the doctor from the comfort of their own home. This will drastically expedite the medical check-up process as it will save time for both the doctor and the patient. However, I feel that this will present issues of its own. Although I do not doubt the feasibility of this practice, it is already possible with existing technology, I do have doubt over the quality of the medical consultations provided through video conferencing. Without the physical presence of the patient, the doctors will be unable to do a detailed check-up on the patient that will draw on their own experiences and knowledge as a medical professional. Instead, the bulk of consultation will then have to rely on the information provided by the patient over video conference due to the lack of proximity. There is then a shift of responsibility of provision of relevant medical information from someone who knows the human anatomy a little better to someone who doesn't and might not be in the best position to provide such decisions due to sickness, etc. Nonetheless, there is still great potential in this service.


Overall I will rate this lesson 8/10. The session was very informative and exposed me to an new, interesting industry sector.

Sunday 22 September 2013

TWC Session 5

Session 5 was focused on Information and Communications Technology and how it changed the world. The lesson started with the introduction of the evolution of the internet. The shift from Web 2.0, where the the user communicates to the system, towards Web 3.0, where the systems communicates to other systems and users. This new system will allow greater integration of technology into our daily life by allowing the various devices we use to communicate to one another, allowing our information and preferences and location to be essentially stored in the “clouds”. This will be about a revolution of how we interact with technology and certainly bring about great convenience. However, this systems will also potentially expose us to more risks as well. Since the bulk of our personal information are stored on the web, there will be significant privacy and security concerns, where government or otherwise, will potentially tap into this vast reserve of confidential information to control, censor or take advantage of users. Then again, all new technology comes with risk and potential for abuse. We must then determine to what extent do we want our life to be integrated into the cloud.


If you consider status quo, we are already, to a great extent living in the cloud. Since the advent of social media firm, we are already in the process of ceding, to a certain degree, our private, confidential information to the web. Facebook, Twitter dictate our social life while LinkedIn, XING portray our professional image. The rise of such firms has already changed social interaction. The rise of social media and other forms of ICT have allowed us to keep in touch with more people more easily. Such convenience has promoted the the spread of ideas and ideals. One prime example would be how social media was used to circumvent oppressive regimes such as during the Arab Spring or in Tibet.


Kofi Annan, Former Secretary-General of the United Nations said “Today’s real borders are not between nations, but between powerful and powerless, free and fettered, privileged and humiliated.” The expansion and lowering cost of access to ICT in the world can in help the powerless, fettered and humiliated to cross that border. Cheaper and faster access to information has helped lower poverty in many countries. ICT has facilitated the spread of ideas and technology, where the technological innovations from first-world countries would eventually filter to the third-world countries. Farmers in China now use wireless technology to gain access to up to date prices and value of their crops so that they will not get ripped off by wholesalers. Access to weather information allowed them preempt and prepare for any potential natural disasters coming their way. Freedom of access to information has increased accountability and transparency of both government and corporations. In many ways, the borders are shrinking.


However, there's still much we can do. There are still many in the world living without ICT and are unable to benefit from the revolution of information accessibility and adoption. With the world moving at such a rapid pace, the gap will only get bigger. Also, ICT have also been exploited to restrict and control information. As seen in oppressive countries like China's Great Firewall. Even in democratic countries like the US and UK, ICT have allegedly been used to conduct surveillance on its own citizens.


This session was highly informative and very interesting. I give this session 8/10. 

Sunday 15 September 2013

TWC Session 4

In session 4 the class started with drivers of world change. One driver that I found to be particularly interesting was the environmental factor. “If everyone consumed as much energy as the average Singaporean and U.S. resident, the world’s oil reserves would be depleted in 9 years”. It's a scary thought but nonetheless a realistic one. The class has been focusing on sustainable development recently so I did a little digging on my own. I found out that our resources are running out fast. At today's rate of consumption, oil will be depleted in 46 years, gas and copper years in 60, tin and lead years in 40, zinc in 46 years. There's plenty of coal, enough to last about 180 years, but we'll probably all choke out before we finish burning them all. The point here is: We're running out of stuff. The dawning of this realization has sparked the “green” revolution where we saw the advent of many “green” technology and a shifting of focus towards more clean and renewable sources of energy and resources.

Next we moved on to “Change Management and Change Leadership”. A interesting video on leadership was shown where a lone guy dancing could actually spark off a movement. This got me thinking if it can be applied to the technology adoption graph from the first half of the session. Much of the world change is brought on by innovative, brave people who dared to boldly go where no man has gone before. People like Steve Jobs, Steve Wozniak, Steve Ballmer are the innovators and technology enthusiasts. But all the brilliance of the Steves are for naught if not for the early adopters of the technology, the first Macintosh users who dared go against the conventional Windows. These people proves that what the Steves are doing is right and affirms them by adopting the new technology. Then comes the tipping point, the number of users explodes with the early majority pragmatists who wants to join into the growing Apple fanbase and subsequently the late majority conservatives and finally the laggards and skeptics. And now the question is: Which group do you think you are? And which group do you want to be in?


I rate this lesson 8/10. The session provides a nice overview on the adoption of technological progress and an interesting view on leadership.

Sunday 8 September 2013

Individual Topical Review Paper Outline

Background/Introduction


What is cryogenics – cryogenics is the study of the production of very low temperature and the behavior of materials at those temperatures.


Focus on medical applications – cryosurgery and cyronics.


What is cryosurgery and cyronics?


Historical Perspective (ie where we have come from)


History of cryosugery and cyronics


Current Situation (ie where we are today)


Current applications in cryosurgery.
- how cryosurgery have changed surgical procedures
- current applications
- benefits of cryosurgery


Leads on to:

Cyronics
- Benefits of cyronics
- Risks of procedure
- Ethical issues
- Current applications


Future Considerations
Cyronics – complete preservation of the human body

Conclusion


TWC Session 3

Interesting topics were covered today. The first part of session 3 was focused on sustainability where the prof introduced to use the the linear and cyclical model. How societies are gradually shifting from an unsustainable, highly extractive linear model to a sustainable cyclical model where every process along a product's life cycle, extraction, production, consumption, disposal gives something back to the environment so that the carbon footprint/impact of the product is reduced to a minimum. More corporations are recognizing impact of the environment an internality rather than externality, allowing they to take into consideration the impact of their product on the environment as an actual quantifiable cost instead of a mere nuisance.


But my question here is then, who will bear the cost? The consumers or the producers? If the industries pass on the cost to the consumers, how will we be convinced that the industries will really use the mark-up to contribute to sustainability instead as a mere tool to rake in more profit? Should the industries absorb the cost, then how could companies contribute towards a cyclical model? Also,
do consumers really care? Personally, I don't. When I buy a product, I only look to the short term benefits of the product. How I could use it tomorrow or next week not 5-10 years down the road. By then new, better stuff would have come up and then I'll be considering how the better stuff could be used the next day or the week after. This I believe is the mentality of most of the consumers. Even if they've bought something sustainable, something that lasts 20-30 years, most of us would not use that product to the full extent. We'll most probably rush to the market at the sight of the new versions of the product. Thus negating the environmental benefits that the product brings and just allows the consumers to justify buying more stuff.


The second half of the lesson was focused on innovation. A few interesting models came up. The RDA model. Research, development and application which focuses on the process of innovation and the valley, summit and cloud framework which for me is more applicable to identifying opportunities in the business arena. One interesting point raised here was should innovation be technology-driven or market-driven? The former place emphasis on creating new markets using new technology while the latter focuses more on innovation on existing markets. The conclusion was it's only advisable to adopt the technology-driven approach if you have enough capital and time. Creating new markets takes time but once you've created the market, you'll hold monopoly over the sector. High risk, high rewards. However, lacking those factors, innovation should then be market-driven. The market for the product already exists. The upside is innovation is merely improvements on existing products, the downside is others are thinking of the same thing. The problem with market-driven products is that there will be competition eroding on your market-share, aka profits.



I would rate this session a 8/10. It was a very informative session.