Day 1 :
Keynote Forum
Yoshiaki Omura
International College of Acupuncture & Electro-Therapeutics, USA
Keynote: Problems associated with currently used hypertension treatment and their potential improvements of excessive blood pressure, blood glucose ns body weight by the individualized optimal dose of each medication plus addition of optimal dose of Vitamin D3 using its unique 7 beneficial effects
Time : 9:50 AM - 10:30 AM
Biography:
Yoshiaki Omura is an Originator of Bi-Digital O-Ring Test. He is the President of International Association of Bi-Digital O-Ring Test Medical Societies. He is also an Adjunct Professor of Family & Community Medicine, New York Medical College and President of International College of Acupuncture & Electro-Therapeutics. He is also a Former Director of Medical Research, Heart Disease Research Foundation.
Abstract:
As a cause of hypertension, there are 10 causes that are shown by NIH and Mayo Clinic, although role of infection, particularly chlamydia pneumoniae are not included in these lists. Unfortunately, most doctors give prescribed combination of variety of medicine based on the Physician’s Desk Reference, which is also known as PDR. Without figuring out individualized, optimal doses, therefore, prescribed amounts of medications are overdosed for the people over 50 or 60 years old. Usually, optimal dose is proportional to physical activities. In spite of the large body weight, optimal dose is often less than adult with average activity and the actual individual, optima dose is also often reduced as average adult. As a result, often overweight people with little body movement receive excessive toxic dose of the medication. In addition, there is a general tendency to not only test each drug’s optimal dose, but they also do not examine drug interaction which may create toxic effect. We see this often and our study indicates that among the infections, which may be associated with hypertension and chlamydia pneumoniae. As a result, for treatment of some of the mild hypertension ends up as more serious problems to hurt brain and the vascular system. According to our study, we found the optimal dose of Vitamin D3 is essential for many people who do not have sufficient, active form of Vitamin D3. The author also found Vitamin D3 deficiency is very common, but many doctors often give excessive dose of Vitamin D3 instead of optimal dose. Our study with optimal dose of Vitamin D3 indicated it has 7 unique, beneficial effects, which include significant anti-cancer effects, significant increase in DHEA levels and acetylcholine for those who have a reduced amount and has a very significant urinary excretion of viruses, bacteria, fungi and single-cell parasites, asbestos, mercury and aluminum as well as other toxic substances. We have also recently found that the continuous use of individually determined optimal dose of Vitamin D3 often reduces both systolic and diastolic blood pressure gradually. Using these unique beneficial effects of Vitamin D3 we found some of the overweight patients with diabetes and high blood pressure and they were given overdose of medication in spite of the extremely reduced body movements. Many treatments to reduce the body weight failed but by reducing to the optimal dose of anti-hypertensive drugs and anti-diabetic drugs plus optimal dose of Vitamin D3 for every 8 hours, some patient’s blood pressure and blood sugar level became close to normal and body weight significantly reduced. Many attempts to reduce the body weight in the past all failed but just giving optimal dose of all the medication taken, which are compatible with each other without creating toxic effect and adding only optimal dose of vitamin D3. By reducing each drug to optimal dose and eliminating drugs which inhibit other drugs as well as Vitamin D3, in a matter of 1 month in some patients we had a very significant reduction of bodyweight, blood pressure. This simple approach should be tried for resistant, hypertensive patients, particularly with high blood sugar or patients who are overweight. At least it is worth trying.
Keynote Forum
Hiroshi Ohrui
Yokohama University of Pharmacy, Japan
Keynote: EFdA: An extremely excellent anti-HIV nucleoside from design to the current clinical trials results
Time : 10:30 AM-11:10 AM
Biography:
Hiroshi Ohrui has received his PhD degree (1971) from The University of Tokyo, Japan. He has Joined RIKEN (1966) and moved to Tokyo University (1981) and then to Yokohama University of Pharmacy (2006). He has worked for Dr. J. J. Fox at Sloan-Kettering Institute for Cancer Research (1972-1973) and Dr. J. G. Moffatt at Syntex Research (1973-1974). He has received several awards including Inoue Prize for Science (2001), Japan Prize for Agricultural Sciences (2004), The Japan Society for Analytical Chemistry Award (2004) and Japan Academy Prize (2010). His research interests cover organic synthesis, chemical biology and chiral discrimination.
Abstract:
4’-C-Ethynyl-2-fluoro-2’-deoxyadenosine (EFdA) has attracted much attention due to its extremely excellent anti-HIV activity; prevent the emergence of resistant HIV mutants, over 400 times more active than AZT and several orders of magnitude more active than the other clinical reverse-transcriptase inhibitor 2’,3’-dideoxynucleoside drugs, very low toxic, long acting, could be used for prophylaxis, and so on. EFdA is now under clinical investigation as MK-8591 by Merck & Co. General idea for the development of anti-viral nucleoside based on the mutation of viruses and the development of EFdA, especially the design of it, will be presented and discussed. For the design of the modified nucleoside which could solve the problems the clinical drugs have: (1) Emergence of drug-resistant HIV-mutants, (2) Adverse effects by drugs, and (3) Necessary to take plenty amount of drugs. The following working hypotheses to solve the problems were proposed: (1) The way to prevent the emergence of resistant HIV mutants, (2) The way to decrease the toxicity of modified nucleosides, and (3) The way to provide the nucleoside with the stability to both enzymatic and acidic hydrolysis of nucleobase for long acting. 4’-C-substituted-2’-deoxynucleoside was designed to meet the hypotheses (1), (3) and the two-site-modification was conducted to meet the hypothesis (2). The details of the hypotheses and the reason of the 4’-C-substitution will be discussed. To prevent the deamination of adenine base, fluorine atom was introduced at the 2-position of adenine base. Finally, EFdA which is modified at the two position of the physiologic 2’-deoxyadenosine and has extremely excellent anti-HIV properties been successfully developed
Keynote Forum
Bruce Gelb
NYU Langone Transplant Institute, USA
Keynote: Tackling the challenge of acute rejection prevention in VCA transplantation: A novel approach utilizing T cell and mature B cell depleting induction
Time : 11:30 AM - 12:10 PM
Biography:
Dr. Bruce Gelb, MD FACS is an Assistant Professor of Surgery at the NYU Langone Transplant Institute. He performs liver, kidney, pancreas, and living donor transplant surgery, as well as a key member of the Face Transplant team, leading the development and management of the immunosuppression regimens for the VCA program. He also serves as the Chair of the Quality Improvement Committee of NYU Langone Health. Dr. Gelb also serves on the United Network for Organ Sharing (UNOS) Ethics Committee. Dr. Gelb is concerned with a variety of issues in bioethics, with particular interest in the ethics of transplantation. He currently serves as the President of the Board of Directors of the Global Bioethics Initiative, an NGO member of the United Nations Academic Impact with special consultative status with the UN Economic and Social Council.
Abstract:
Vascularized composite allotransplantation (VCA) is defined as “the transplant of intactvascularized body parts, such as hands and faces.” The first successful handtransplant was performed in France in 1998, and the field has expanded to include faces, abdominal walls, arms, legs, scalp, and reproductive organs. From a technical standpoint, feasibility has been proven, as is evidenced by graft and patient survival rates comparative to or exceeding that of solid organ transplant. To date, more than 200 of these procedures have been performed world-wide. Each procedure is necessarily unique.As the field makes the transition from purely experimental to becoming a standard of care, there are notable ethical issues specific to VCA: Are the quality of life and psychological benefits sufficient to justify the operative risk and medical risks associated with life-long immunosuppression therapy for a non-life saving procedure? Is the procedure economically justifiable? Can recipient and donor privacy and anonymity be sufficiently protected in a time of extreme human interest and media attention in these procedures? How do we determine who is an appropriate candidate for this procedure? What is the appropriate timing in relation to the original injury? What should the legal and regulatory framework be to determine which procedures are appropriate currently?It is necessary to have consensus in approaching these issues both thoughtfully and realistically if the field of VCA transplantation is to survive and mature over the next 20 years
Keynote Forum
Chris Elliott
Leman Micro Devices SA, Switzerland
Keynote: Novel techniques for measuring blood pressure
Time : 12:10 AM-13:00 AM
Biography:
Chris Elliott is a Fellow of the UK Royal Academy of Engineering and a Barrister (trial lawyer) specializing in regulated technology. He has wide experience of the development of leading-edge technological products and their regulatory approval. For the last 7 years, he has specialized in the innovative measurement of blood pressure and the clinical exploitation of the results
Abstract:
Non-invasive measurement of blood pressure dates from the late 19th century, when Riva-Rocci proposed occlusion and then Korotkoff identified the characteristic turbulent sounds. Little changed until the 1980s when Penãz unloading emerged and then pulse wave velocity. There have recently been many announcements of novel techniques and products to measure BP without a cuff, both for clinical and consumer use and for continuous or on-demand monitoring.
The workshop will start by reviewing the underlying challenge of measuring blood pressure, including consideration of its variability and the conditions under which it must be measured. The performance of the “gold standard” will be presented.
Before considering specific novel techniques, the workshop will examine the physics and physiology of arteries that forms the basis for two different approaches. This will include the stress/strain law applies to artery walls and its implications for the direct and indirect ways of estimating the pressure non-invasively. This will expose some traditional myths, such as that the maximum change in arterial area is found at Mean Blood Pressure and the assumption that the dynamic stiffness is solely a property of the artery wall.
That background will introduce the two divergent approaches, based on direct measurement of pressure and indirect measurement of wave velocity. The workshop will then consider in detail seven examples of products that illustrate each of the approaches, including those intended for professional use and those intended for the consumer, and also considering both continuous monitoring and on-demand devices. The examples range from NexFin and Caretaker through to the Asus watch and the development by the author’s company. It will end with a short review of a further eight devices of projects and some observations about the implications for clinical practice
- Organ Transplantation Surgery
Location: 1
Chair
Yusuf Gunay
University of Pittsburgh Medical Center, Pittsburgh, USA
Co-Chair
Medhat Askar
Director, Transplant Immunology, Baylor University Medical Center, USA
Session Introduction
Sang Soo Kim
Pusan National University Hospital, South Korea
Title: Non-albumin proteinuria as biomarker for early diabetic kidney disease: Beyond albuminuria
Time : 13:50 - 14:20
Biography:
Sang Soo Kim had focused at his research area to establish the pathogenesis of diabetes and its complication and to identify novel methods for early diagnosis and treatment of diabetic complications at Pusan National University Hospital. He had participated in a number of randomized clinical trials as Principal Investigator or Sub-Investigator. Specially, he had published a number of original articles related to diabetic complication (diabetic nephropathy and neuropathy) at peer-reviewed international journals. As a Visiting Scholar, he had conducted experimental studies for hypothalamic metabolism at Division of Endocrinology and Diabetes and Metabolism at Beth Israel Deaconess Medical Center, Harvard Medical School for 2 years.
Abstract:
The increasing number of people with diabetes has had a major impact on the prevalence of diabetic kidney disease, which is a metabolic disorder with high morbidity and mortality and is the leading cause of End-Stage Renal Disease (ESRD). To improve the lives of people with diabetic kidney disease (DKD) and to reduce the impact on society, early identification of the development or progression of DKD using appropriate screening and diagnostic tools is very important in order to provide timely and proper management. Albuminuria is considered as a sensitive marker of Chronic Kidney Disease (CKD) and Cardiovascular Disease (CVD) risk, and is used as the first clinical indicator of DKD. Although the presence of urinary albumin is recognized as an early marker of DKD, significant glomerular damage has already occurred by the time albuminuria is apparent. It has been suggested that Non-Albumin Proteinuria (NAP), rather than albuminuria, might be an important biomarker for early detection of the development and progression of DKD. We recently demonstrated that urinary NAP might be a sensitive and specific marker of tubular damage that predicts renal impairment in type-2 diabetic patients. Furthermore, non-albumin proteinuria showed additional value over and above that of albuminuria for predicting the progression of CKD in patients with type-2 diabetes. Whereas, there is no doubt that hypertension plays a pivotal role in developing DKD. Thus, the role of NAP as biomarkers in hypertensive disorder might be considered quite interesting in the future.
Janez Rozman
Medical Faculty, University of Ljubljana, Slovenia
Title: A model and setup for selective infrared stimulation of isolated porcine vagus nerve
Time : 14:20 - 14:50
Biography:
Janez Rozman, Ph. D. was born in Novo mesto, the Republic of Slovenia, in 1956. In 1982 he finished his engineering degree at the Faculty of Natural Science at the University of Ljubljana in the Republic of Slovenia. He received a M.Sc. degree in 1988 from the same institution. The title was: Electron Microscopic Investigation of the Surface of Electrodes of Implants Removed from Human Tissue. In January 1993, he finished his dissertation entitled: Selective Stimulation of Nerve Fibers at Faculty of Electrical Engineering University of Ljubljana. In January 1994, he his colleagues have established a small research company ITIS d. o. o. Ljubljana and formed his own research group Center for Implantable Technology and Sensors. His research interests concern investigation of possibilities in selective stimulation of autonomic nerves, ganglia, glands and other organs to improve their function in disease. Link to the references:http://izumbib.izum.si/bibliografije/Y20170120172405-A2227555.html.
Abstract:
Statement of the Problem: Electrical nerve stimulation has been widely applied in both neuroscience and clinical practice. Among numerous alternative neuro-modulation techniques, opto-thermal methods are becoming more and more popular. The foremost advantage of using infrared light (IR) pulses for nerve stimulation over electrical methods is high spatial resolution, lack of stimulation artifacts and lack of electrochemical processes.
Methodology & Theoretical Orientation: As concluded by Wells et all. (2007), neuronal activation using IR occurs mainly by a photo-thermal mechanism due to IR-induced brief temperature transients (dT/dt and dT/dx). The rapid temperature rise induces a transient change in the electrical capacitance of the neuron's plasma membrane, which in turn depolarizes the cell and induces a propagating action potential (AP). The wavelength was chosen based on the desired penetration depth in the nerve tissue. We propose to use short-wavelength infrared (SWIR, IR-B DIN) light with wavelength of 1936 microns emitted by a Light Emitting Diode and conducted using an optical fiber.
Findings: We developed the equipment including a measuring chamber, a SWIR source, optical chopper, multi-electrode recording spiral nerve cuff and CAP amplifier. The stimulator is capable of delivering extremely steep rectangular SWIR pulses ranging from 100 to 500 µs and energy of up to ∼1 J∕cm2. The induced thermal transients should have a highly localized nature and fast temporal dynamics within the particular superficial region of on an isolated porcine vagus nerve.
Conclusion & Significance: This report describes the challenges related to the development of IR neuro-modulation therapies. Results will be relevant for further development of the VNS methods and implantable systems to be potentially used in clinical practice.
Bruce Gelb
NYU Langone Transplant Institute, USA
Title: Vascularized allograft transplantation: Ethical challenges in a brave new world
Time : 15:40 - 16:10
Biography:
Dr. Bruce Gelb is an Assistant Professor of Surgery at the NYU Langone Transplant Institute. He performs liver, kidney, pancreas, and living donor transplant surgery, as well as a key member of the Face Transplant team, leading the development and management of the immunosuppression regimens for the VCA program. He also serves as the Chair of the Quality Improvement Committee of NYU Langone Health. Dr. Gelb also serves on the United Network for Organ Sharing (UNOS) Ethics Committee. Dr. Gelb is concerned with a variety of issues in bioethics, with particular interest in the ethics of transplantation. He currently serves as the President of the Board of Directors of the Global Bioethics Initiative, an NGO member of the United Nations Academic Impact with special consultative status with the UN Economic and Social Council.
Abstract:
Vascularized composite tissue allotransplantation (VCA) has become a feasible reconstructive option for patients with severe disfiguring injuries not otherwise amenable to conventional reconstructive techniques. Approximately 200 VCA transplants have been performed worldwide to date, 40 of which have been partial or full-face transplant surgeries. The incidence of rejection exceeds 80% in the face transplant population. This unacceptably high rate of early acute rejection is significantly higher than in abdominal and thoracic transplantation and has been attributed to the increased immunogenicity of skin containing grafts as well as frequent sensitization of the transplant recipient related to treatment of the original injury with allogeneic skin grafts and frequent blood transfusions. In August 2015, our transplant center performed the most extensive full face transplant in the world to date in a patient with a positive flow crossmatch (negative CDC crossmatch) utilizing a novel induction immunosuppression regimen targeting depletion of T cells and mature B cells utilizing rabbit anti-thymocyte globulin and a single dose of anti-CD20 monoclonal antibody. The patient has been maintained on standard triple drug maintenance therapy (tacrolimus, mycophenolate, and prednisone).
At 35 months post-transplant, the recipient remains free from any rejection episode. Periodic biopsies have been performed to confirming absence of histopathologic evidence of rejection. The same induction regimen has been utilized in a second patient with similar early results.Early acute rejection in VCA transplant occurs at an unacceptably high rate. Prevention of rejection episodes may improve long-term outcomes as has been seen in solid organ transplantation. We are cautiously optimistic that this novel induction strategy targeting B and T lymphocyte depletion, along with conservative tapering of maintenance immunosuppression, may reduce the rate of early rejection in facial VCA.
Ramesh K Batra
Yale University, USAl
Title: Age based living kidney donor selection: A bipartite ethical dilemma
Biography:
Ramesh K Batra is a Multi-Organ Transplant Surgeon at Yale University, USA. He has a special interest in bioethics in organ transplantation and is undergoing Higher Education in Ethics. His special interest includes maximum utility of deceased donor and living donor organs and how best to allocate the limited resource of organs.
Abstract:
The first kidney transplant in 1954 set the precedent for success of living donor kidney transplants for End Stage Renal Disease (ESRD) patients across the world. Kidney transplant from a deceased or a living donor in general is the gold standard treatment for ESRD patients over dialysis. The survival benefit offered is significantly higher with a Living Donor Kidney Transplant (LDKT) in comparison to a Deceased Donor Kidney Transplant (DDKT). Amongst the LDKT, much similar to the results for a DDKT, it is observed that a younger donor kidney leads to a longer graft and patient survival. Therefore, when a recipient with multiple donor options is evaluated by a transplant center, whilst controlling for other factors, a younger age becomes a preferred choice whilst selecting the appropriate donor. Therefore, it appears that selection of a living kidney donor is more likely based on the recipient outcome. But, from a purely living kidney donor perspective, the impact of nephrectomy on life expectancy and cumulative risk of ESRD worsens with advancing age of the donor. This impact is more pronounced for black males as compared to white. So, a younger black donor suffers higher long-term risks after kidney donation, although they provide a superior quality allograft for the recipient. Similarly, following a utilitarian approach, Estimated Post Transplant Survival score (EPTS) should also be applied to living donor kidney recipients when encountered with multiple donor options. A living donor transplant is geared with the primary responsibility towards minimizing risks to the donor and this consideration should be followed when choosing between a donor, rather than the objectivity of age. This consideration should also include the recipient age and their life expectancy to achieve maximum utility of the donated allograft, by utilizing the EPTS score.