Essays on same sex marriage debate

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Essay: Gene transfer techniques – pros and cons. Gene transfer is a technique to stably and debate efficiently introduce functional genes (that are usually cloned) into the target cells. Genetic transfer is the essay occurrence owl, mechanism by which DNA is transferred from essays on same sex marriage debate, a donor to a recipient. Once donor DNA is inside the recipient, crossing over can occur. The result is a recombinant cell that has a genome different from either the donor or the recipient. A recombination event must occur after transfer in order that the change in the genome be heritable (passed on debate to the next generation).The genes are the blueprints essential to generate all the proteins in our bodies which eventually perform all the biological functions. Therefore, when a gene is efficiently introduced into a target cell of the host, the protein which is encoded by that gene is produced . Gene transfer technologies developed initially as a research tool for studying the essays on same sex marriage debate, gene expression and its function. A range of techniques and naturally occurring processes are utilized for robert frost and ice paper, the gene transfer. Techniques are available for the introduction of essays, DNA into many different cell types in culture, either to study gene function and violence essay regulation or to produce large amounts of recombinant protein. Cell cultures have therefore been used on a commercial scale to synthesize products such as antibodies, hormones, growth factors, cytokines and viral coat proteins for immunization.The most important application of this technology is in vivo gene therapy, i.e. the introduction of DNA into the cells of live animals in order to treat disease.

The extraordinary potential of altered DNA molecule is to give rise to new life-forms that are better adopted for survival. Change in base sequence of DNA leads to change in essays on same protein causing disease condition which can be corrected by manipulation of plan, gene. Much emphasis has been given to the gene manipulation in cardiovascular diseases, parkinson’s disease, lysosomal disorders, ocular gene therapy and osteoarthritis. Overview of gene-transfer strategies: Gene transfer can be achieved essentially via three routes. The most straightforward is direct DNA transfer, the physical introduction of foreign DNA directly into the cell. Essays On Same Debate? For example, in on same debate cultured cells this can be done by microinjection, whereas for cells in essays sex marriage debate vivo direct transfer is often achieved by bombardment with tiny DNA-coated metal particles. Robert Fire And Ice? The second route is termed transfection, and this encompasses a number of techniques, some chemical and some physical, which can be used to persuade cells to take up DNA from their surroundings.

The third is to essays sex marriage debate, package the DNA inside an. animal virus, since viruses have evolved mechanisms to naturally infect cells and introduce their own nucleic acid. Robert Research Paper? The transfer of foreign DNA into a cell by this route is termed transduction. The choice of methods of DNA transfer depends upon the target cells in essays sex marriage debate which transformation will be performed. It also depends upon the objectives of gene manipulation. Bridge Essay? The transfection may be either stable or transient. Although, choice of DNA transfer method is very important, the other important steps are selection of gene, isolation of gene, preparing recombinant DNA and selection of transformed cells. The regeneration of sex marriage, organism with new characteristics is also equally important. The delivery of genes in vitro can be done by treating the cells with viruses such as retrovirus or adenovirus, calcium phosphate, liposomes, particle bombardment, fine needle naked DNA injection, electroporation or any combination of these methods.

These are the powerful tools for research and have possible applications in gene therapy. FACTORS TO CONSIDER WHEN SELECTING A GENE DELIVERY METHOD. The advancement of and ice, new technologies has made gene delivery both more efficient yet more confusing given the formidable array of reagents and essays sex marriage methods now available. Essay? Determining the best gene delivery approach for any particular experiment requires careful consideration of a number of different factors as stated below. 1. On Same Debate? Cellular Context or Environment – The context or environment of the cells (i.e., in vivo vs. in. vitro vs. Plan? ex vivo) to which nucleic acids will be delivered is the first factor to consider when. deciding upon a gene transfer method.

The obstacles and essays on same debate challenges posed by delivery to in. vitro cell cultures are very different than those posed by in vivo or ex vivo cells, and require. different tools and techniques for overcoming them. For example, targeting nucleic acids to. particular cells while avoiding other cells is usually a major concern for in vivo gene transfer. applications, sometimes a concern for ex vivo applications, but usually not a concern for in vitro. Another important issue that must be addressed when planning in vivo (but not in vitro) gene. delivery studies is the robert fire and ice research, immunogenicity of the gene transfer system. This is particularly important when considering the use of certain viral vectors discussed previously, which may be highly immunogenic.

Also related to immunogenicity is the sex marriage, issue of general safety, both for sectarian violence in pakistan, the experimenter and for the subject of essays on same debate, any study utilizing transfection. Almost always, the use of viral vectors requires very extensive safety precautions than does the sectarian in pakistan essay, use of synthetic transfection methods. 2. Essays? Cell or Tissue Type – The origin of the cells or tissue to which nucleic acids will be. transferred is typically the second parameter considered when selecting a gene delivery. method. Robert Fire And Ice? For a number of different reasons, the sex marriage debate, difficulty of cellular nucleic acid delivery varies. from cell type to cell type. Because of this, it is frost fire and ice, always important to review the literature to. determine if the cell type of interest has previously been utilized for gene transfer experiments, which exact methods have been used, and what delivery efficiencies were achieved, i.e., what. percentages of cells actually transfected or transduced, with each method.

Certain cell types are often described as ‘notoriously difficult to transfect’. These include primary cell cultures of many varieties. Successful gene transfer to on same sex marriage debate, such cells. usually requires a good deal of research before selecting any particular gene delivery method. 3. Delivery Efficiency – For most applications, transfecting or transducing as many cells as.

possible is preferred, especially when it is necessary to college, detect the presence of rare transgene. products. Thus, it is important to determine the level of delivery efficiency required for a given. application before deciding on a particular gene transfer method. In most cases, it is on same sex marriage, found that.

viral vectors provide the highest delivery efficiencies. For some commonly used and easily transfected cell lines, cationic lipids nearly match viral vectors in their gene transfer efficiency, while providing safer and much quicker procedures. 4. Stable vs. Transient Gene Delivery – Gene transfer procedures are frequently categorized. by whether the delivered gene remains separate from the host cell chromosome or whether it is integrated into the host cell chromosome. In the first case, known as transient gene delivery, expression of the transgene typically dissipates after a given period of time – usually within. several days – because the expression vector is either degraded or expelled from the host cell.

In the college outline, second case, known as stable gene delivery, expression of the transferred gene is. prolonged, or stable, because the vector is integrated into the host cell chromosome. Obviously, different applications require different time periods of transgene expression. Debate? Thus, a careful. comparison between different gene delivery methodologies will allow a suitable choice for. generating the desired transient or stable expression. In the degree plan, case of essays on same sex marriage, viral vectors, determining whether a particular virus is suited for stable or transient. transduction is on same, simply a matter of essays on same sex marriage debate, learning the general characteristics of the robert fire and ice, vector. In the case.

of chemical or physical/mechanical gene transfer, determining whether a given method is. suitable for transient vs. stable delivery may be as easy as reading sales literature from the. manufacturer or checking primary research literature. 5. Type of Delivered Molecule – Another factor to consider when selecting a gene delivery. method is what type of nucleic acid or other molecule is being transfected or transduced. For. example, a reagent that efficiently delivers plasmids may not efficiently deliver DNA. oligonucleotides.

It is frequently easiest to simply review the essays on same sex marriage, literature to learn what methods have been used successfully, and to contact other researchers who have experience delivering the molecule of interest. 6. Cytotoxicity – Another issue that comes up frequently when choosing among different gene. delivery methods is the cytotoxicity of the various methods and reagents. Some methods, such. as electroporation and do my gene guns, can be extremely harsh on cells and often result in essays on same the death. of a majority of cells. Also, the DEAE-dextran can be quite harsh on some cell types, especially. when a DMSO or glycerol shock step is used as part of the procedure. In some applications, such as when a small number of bridge creek essay, transfectants are required from a recalcitrant cell type, this is.

not a problem. In the majority of applications however, a high percentage of cell death is simply. not acceptable. On Same Debate? The plethora of bridge owl, available cationic lipids and polymer reagents have varying. degrees of toxicity with different cell types, and their concentrations during transfection can be. optimized as needed to minimize cell death. 7. Suspension vs. Adherent cells – Most commonly transfected cells grow – and are. transfected – while attached to some type of support, whether that support is the tissue from. which they are derived, some inert membrane or scaffolding, or the surface of a tissue culture.

plate. Less common are cells that grow while suspended in medium, such as those derived from. blood and other bodily fluids. Suspension cells are generally more difficult to on same, transfect; therefore, it may be necessary to essay outline, rely on harsher gene delivery methods, such as. electroporation, gene guns, microinjection, or viral vectors for on same sex marriage debate, acceptable transfection levels. Also, some cationic lipids can effectively transfect suspension cells, and should be tried when.

possible due to do my, their simplicity and cost-effectiveness. 8. Expertise – The degree of difficulty in performing the various transfection techniques can. vary significantly, and therefore the expertise and essays debate experience of the researcher is do my paper in india, usually an. important factor to consider. For example, methods like microinjection viral transfection methods are invariably more complex than cationic lipids and polymer reagents. Also, of the chemical methods, calcium phosphate co-precipitation can be quite tricky due to its sensitivity to slight changes in experimental conditions. 9. Time – Another important factor to consider is the essays sex marriage, time required for gene delivery.

Viral. methods, while highly efficient, can be quite time consuming, typically taking anywhere from two weeks to robert frost and ice research, one month to sex marriage debate, complete. In contrast, chemical and physical/mechanical methods can usually be completed within a few days, but frequently provide lower transfection efficiencies. Thus, it is not uncommon to robert fire and ice research paper, have to weigh the benefits of faster results and less labor against the benefit of higher efficiency. 10 Cost – Finally, cost can be a major factor when deciding on the best gene delivery. method for a given application. The most expensive methods tend to be the. physical/mechanical methods, such as electroporation and debate gene guns, due to the specialized.

equipment they require.Viral gene delivery is perhaps the second most expensive method, since it requires the vector reagents, extensive time and labor to complete lengthy vector preparation procedures, as well as proper disposal of bridge creek essay owl, viral waste materials. The third most expensive gene delivery methods utilize polymers and cationic lipids, which do not require any specialized equipment or lengthy viral vector preparation steps. Such reagents typically cost in the hundreds of dollars, depending on the number of transfections to be completed. Finally, the least expensive methods utilize calcium phosphate, which is a cheap and sex marriage debate abundant mineral, and naked DNA, which obviously requires no transfection reagent cost, but can be highly inefficient. GENE TRANSFER TECHNIQUES. Transformation is the debate, naturally occurring process of essays debate, gene transfer which involves absorption of the sectarian, genetic material by a cell through cell membrane causing the fusion of the foreign DNA with the native DNA resulting in the genetic expression of the received DNA. Transformation involves the uptake of essays on same sex marriage, “naked” DNA (DNA not incorporated into structures such as chromosomes) by in india competent bacterial cells. Cells are only competent (capable of taking up DNA) at a certain stage of their life cycle, apparently prior to the completion of cell wall synthesis . Transformation is usually a natural method of gene transfer but as a result of technological advancement originated the artificial or induced transformation.

Thus there are two types called as natural transformation and artificial or induced transformation. In natural transformation, the foreign DNA attaches itself to the host cell DNA receptor and with the help of the protein DNA translocase it enters the host cell. The presence of sex marriage, nucleases restricts the entry of two strands of the DNA, destroys a single strand thus allowing only one strand to violence in pakistan, enter the host cell. Any DNA that is sex marriage, not integrated into in india, the chromosome will be degraded. This single stranded DNA mingles with the host genetic material successfully. The artificial or induced method of transformation is done under laboratory condition which is either a chemical mediated gene transfer or done by electroporation..

Genetic engineers are able to induce competency by putting cells in certain solutions, typically containing calcium salts. Debate? At the entry site, endonucleases cut the DNA into fragments of 7,000-10,000 nucleotides, and the double-stranded DNA separates into single strands. The single-stranded DNA may recombine with the host’s chromosome once inside the cell. This recombination replaces the gene in robert fire and ice research paper the host with a variant – albeit homologous – gene. DNA from a closely related genus may be acquired but, in general, DNA is not exchanged between distantly related microbes.

Not all bacteria can become competent. Conjugation is a means of gene transfer in many species of bacteria. Cell-to-cell contact by a specialized appendage, known as the F-pilus (or sex pilus), allows a copy of an on same sex marriage, F- plasmid (fertility plasmid) to transfer to a cell that does not contain the plasmid. On rare occasions an F-plasmid may become integrated in paper the chromosome of its bacterial host, generating what is known as an essays debate, Hfr (high frequency of recombination) cell. Such a cell can also direct the synthesis of a sex pilus. As the chromosome of the Hfr cell replicates it may begin to cross the pilus so that plasmid and chromosomal DNA transfers to the recipient cell. Such DNA may recombine with that of its new host, introducing new gene variants. Plasmids encoding genes for virulence factors antibiotic-resistance are passed throughout populations of bacteria, and between multiple species of do my, bacteria by conjugation. In the laboratory, conjugation can be used to transfer disrupted genes on essays on same debate a self-transmissible plasmid, to develop a mutant strain. A gene of interest from a recipient E. coli strain is cloned into a self-transmissible vector and maintained in a donor strain for college english essay, genetic manipulation. The deleted gene construct is then transferred by conjugation from the donor strain back into the recipient strain.

Transduction is another method for transferring genes from one bacterium to another; the transfer is mediated by bacteriophages. Sex Marriage? A bacteriophage infection starts when the virus injects its DNA into a bacterial cell. The bacteriophage DNA may then direct the synthesis of new viral components assembled in the bacterium. Bacteriophage DNA is replicated and in india then packaged within the phage particles. Early in the infective cycle the phage encodes an enzyme that degrades the DNA of the host cell. Some of these fragments of bacterial DNA are packaged within the bacteriophage particles, taking the place of phage DNA. As the number of phages increases it breaks open (lyse) the cell. When released from the infected cell, a phage that contains bacterial genes can continue to infect a new bacterial cell, transferring the bacterial genes.

Sometimes genes transferred in essays on same sex marriage this manner become integrated into the genome of their new bacterial host by homologous recombination. Such transduced bacteria are not lysed because they do not contain adequate phage DNA for viral synthesis and these phages can enter an alternate life cycle called lysogeny. In this cycle, all the virus’s DNA becomes integrated into the genome of the paper in india, host bacterium. The integrated phage, called a prophage, can confer new properties to the bacterium. Researchers use transduction as a means of gene transfer as it requires a media like virus for transferring genes from sex marriage debate, one cell to the other. Viruses are thus as a tool to introduce foreign DNA from the selected species to the target organism. There are two types of transduction called as generalized transduction in which any of the bacterial gene is transferred via the bacteriophage to the other bacteria and specialized transduction involves transfer of limited or selected set of genes. Viral vectors for gene transfer:

The use of viruses as vectors for transduction, i.e. the sex marriage debate, introduction of genes into essays debate, animal cells by exploiting the natural ability of the virus particle, within which the transgene is packaged, to adsorb to frost paper, the surface of the cell and gain entry is being employed . Due to the efficiency with which viruses can deliver their nucleic acid into cells and the high levels of replication. and gene expression it is possible to achieve, viruses have been used as vectors not only for gene expression in cultured cells but also for sex marriage, gene transfer to living animals. Four classes of viral vector have been developed for use in english human gene therapy and have reached phase 1 clinical trials. These are the essays sex marriage, retrovirus, adenovirus, herpesvirus and adenoassociated virus (AAV) vectors . Before introducing the individual vector systems,we discuss some general properties of viral transduction vectors. Transgenes may be incorporated into. viral vectors either by addition to the whole genome or by replacing one or more viral genes. This is generally achieved either by ligation (many viruses have been modified to incorporate unique restriction sites) or homologous recombination.

For many applications, it is favourable to use vectors from which all viral coding sequences have been deleted.These amplicons (also described as ‘gutless vectors’) contain just the cis-acting elements required for packaging and genome replication. The advantage of such vectors is their high capacity for foreign DNA and the fact that, since no viral gene products are made, the vector has no intrinsic cytotoxic effects. The choice of vector depends on the particular properties of the do my in india, virus and the intended host, whether transient or stable expression is required and how much DNA needs to be packaged. For example, icosahedral viruses such as adenoviruses and essays on same retroviruses package their genomes into preformed capsids, whose volume defines the maximum amount of foreign DNA that can be accommodated. Conversely, rod-shaped viruses such as the baculoviruses form the capsid around the genome, so there are no such size constraints. There is college english, no ideal virus for gene transfer ‘ each has its own advantages and disadvantages. In recent years, a number of hybrid viral vectors have been developed incorporating the beneficial features of two or more viruses. 1) viral vectors that especially efficient at transducing the intended cell type but not other cell types. 2) retroviruses are particularly proficient at delivering genes to essays on same, dividing cells, such as cancer cells or immortalized cell lines. 1) cannot deliver genes to terminally differentiated cells. 2) viral vectors may be highly immunogenic.

TRANSFECTION BY CHEMICAL METHODS. One of the methods of gene transfer where the genetic material is do my in india, deliberately introduced into the animal cell in view of studying various functions of proteins and the gene is transfection. This mode of gene transfer involves creation of pores on the cell membrane enabling the cell to receive the foreign genetic material. When transformation is carried out in eukaryotic cells it is termed as transfection. 1) Calcium phosphate mediated DNA transfer. The process involves a mixture of isolated DNA (10-100ug) with solution of. calcium chloride and potassium phosphate. . When the two are combined, a fine precipitate of the positively charged calcium and the negatively charged phosphate will form, binding the DNA to be transfected on its surface .Cells are then incubated with precipitated DNA either in solution or in tissue culture dish. A fraction of cells will take up the calcium phosphate DNA precipitate by a process not entirely understood but thought to be endocytosis. Transfection efficiencies using calcium phosphate can be quite low, in the range of 1-2 % . It can.

be increased if very high purity DNA is used and the precipitate allowed to sex marriage debate, form slowly. 1. Frequency is very low. 2. Integrated genes undergo substantial modification. 3. Many cells do not like having the solid precipitate adhering to them. and the surface of essays on same sex marriage debate, their culture vessel. 4. Integration with host cell chromosome is essays on same debate, random. 5, Due to above limitations transfection applied to somatic gene therapy. This technique is used for introducing DNA into mammalian cells. This process has been a preferred method of identifying many oncogenes. 2)DNA transfer by essays sex marriage DAE-Dextran method:

DNA can be transferred with the help of DAE Dextran also. DAE-Dextran may be used in the. transfection medium in which DNA is present. On Same Sex Marriage? This is a polycationic, high molecular weight substance and is convenient for in pakistan, transient assays. The negatively charged DNA binds to the polycation and the complex is taken up by the cell via endocytosis.

If DEAE (diethylaminoethyl )-Dextran treatment is coupled with Dimethyl Sulphoxide (DMSO) shock, then upto 80% transformed cell can express the transferred gene. The advantage of this method is that, it is cheap, simple and can be used for transient cells. which cannot survive even short exposure of calcium phosphate. The major advantages of the technique are its relative simplicity and speed, limited expense, and remarkably reproducible interexperimental and on same sex marriage intraexperimental transfection efficiency. Disadvantages include inhibition of cell growth and induction of degree essay plan, heterogeneous morphological changes in cells. Furthermore, the concentration of serum in the culture medium must be transiently reduced during the transfection. It does not appear to be efficient for the production of stable transfectants. For cells that grow in suspension, electroporation or lipofection is usually preferred, although DEAE-dextran-mediated transfection can be used. Transfer of DNA by polycation-DMSO:

As calcium phosphate method of on same sex marriage debate, DNA transfer is reproducible and efficient but there is paper, narrow range of optimum conditions. DNA transfer by. Another polycationic chemical,the detergent Polybrene is carried out to increase the adsorption of DNA to on same, the cell surface followed by fire research a brief treatment with 25-30% DMSO to debate, increase membrane permeability and bridge creek enhance uptake of DNA. In this method no carrier DNA is required and stable transformants are produced. This method works with mouse fibroblast and chick embryo. LIPOSOME MEDIATED GENE TRANSFER. Liposomes are spheres of lipids which can be used to transport molecules into sex marriage, the cells. These are artificial vesicles that can act as delivery agents for exogenous materials including transgenes. They are considered as spheres of lipid bilayers surrounding the molecule to be transported and promote transport after fusing with the cell membrane.

Liposomes for use as gene transfer vehicles are prepared by college english adding an appropriate mix of bilayer constituents to an aqueous solution of DNA molecules. In this aqueous environment, phospholipid hydrophilic heads associate with water while hydrophobic tails self-associate to exclude water from within the lipid bilayer. This self-organizing process creates discrete spheres of continuous lipid bilayer membrane enveloping a small quantity of DNA solution. The liposomes are then ready to be added to debate, target cells. College English Essay? Germline transgenesis is possible with liposome mediated gene transfer.Lipofection is the most common and generally utilized gene transfer technique in on same sex marriage the recent years and it utilizes cationic lipids. The combined DNA and paper cationic lipids act instantaneously to form structures called as lipoplexes that are more complex in structure than the simple liposomes. Cationic lipids have a positive charge and these form cationic liposomes which interact with the negatively charged cell membrane more readily than uncharged liposomes.

This leads to a fusion between cationic liposome and the cell surface resulting in quick entry by essays on same endocytosis and the delivery of the DNA directly across the plasma membrane. Cationic liposomes can be produced from a number of essay owl, cationic lipids that are commercially available and sold as an in vitro-transfecting agent, termed lipofectin. However this pathway would usually result in the fusion of lipoplexes with lysosomes and undergo degradation. This problem is overcome by utilizing the neutral helper lipids, which are generally included along with the cationic lipid. This allows entrapped DNA to escape the endosomes, reach the essays on same debate, nucleus and sex marriage get access to essays debate, the cell’s transcriptional machinery.The endosomal structure is destroyed by increasing the osmotic pressure created by plan the lipids’ buffering action within the endosomes and by the fusion of the essays debate, lipid with the endosomal membrane. The ability of a lipid to destroy endosomes is one of the main characteristics of a transfection reagent. 2. Long term stability. 4. Protection of nucleic acid from degradation.

5. particularly proficient at delivering genes to dividing cells, such as cancer cells or immortalized cell lines. 6. cationic lipids effectively transfect suspension cells. 1) Cannot deliver genes to paper in india, terminally differentiated cells. A rapid and simple technique for debate, introducing genes into a wide variety of in pakistan, microbial, plant and animal cells, including E. coli, is electroporation. Electroporation uses electrical pulse to essays sex marriage debate, produce transient pores in violence essay the plasma membrane thereby allowing macromolecules into the cells. These pores are known as electropores which allow the molecules, ions and water to sex marriage debate, pass from fire and ice, one side of the sex marriage, membrane to another. The electropores reseal spontaneously and the cell can recover. The pores can be recovered only essay if a suitable electric pulse is applied .The formation of electropores depends upon the cells that are used and the amplitude and essays on same sex marriage duration of the electric pulse that is applied to them. When subjected to electric shock, cells take up exogenous DNA from the suspending solution.

Once inside the cell, the DNA is integrated and the foreign gene will express. A proportion of these cells become stably transformed and can be selected if a suitable marker gene is carried on the transforming DNA. Essay? The most critical parameters are the intensity and duration of the electric pulse, and these must be determined empirically for different cell types. Electric currents can lead to dramatic heating of the on same, cells that can results in cell death. Heating effects are minimized by using relatively high amplitude, a short duration pulse or by using two very short duration pulses. However, once optimal electroporation parameters have been established, the college english essay, method is essays on same, simple to carry out and highly reproducible. Many different factors affect the efficiency of electroporation, including temperature, various electric-field parameters (voltage, resistance and capacitance), topological form of the DNA, and various host-cell factors (genetic background, growth conditions) and post-pulse treatment. General applications of electroporation. 1. Introduction of exogeneous DNA into animal cell lines, plant protoplast, yeast protoplast and bacterial protoplast.

2. Electroporation can be used to increase efficiency of transformation or transfection of bacterial cells. 3. Wheat, rice, maize, tobacco have been stably transformed with frequency upto 1% by this method. 4. Genes encoding selectable marker may be used to introduce genes using electroporation. 5. To study the degree, transient expression of molecular constructs. 6. On Same Debate? Electroporation of early embryo may result in the production of frost and ice research, transgenic animals. 7. Hepatocytes, epidermal cells, haematopoietic stem cells, fibroblast, mouse T and B lymphocytes can be transformed by this technique. 8. Essays On Same Debate? Naked DNA may be used for gene therapy by frost applying electroporation device on animal cells. Advantages of electroporation. 1. Essays Sex Marriage? Method is fast. 3. Applied for a number of cell types.

4. Simultaneously a large number of cell can be treated. 5. High percentage of stable transformants can be produced. 1)Limited effective range of. 1 cm between the electrodes. 2)Surgical procedure is paper in india, required to place the electrodes deep into sex marriage, the internal organs. 3)High voltage applied to tissues can result in irreversible tissue damage as a result of paper in india, thermal heating. The technique has high input costs, because a specialized capacitor discharge machine is required that can accurately control pulse length and amplitude. 4) Larger numbers of essays on same debate, cells may be required than for other methods because, in many cases, the most efficient electroporation occurs when there is bridge essay occurrence owl, up to essays on same, 50% cell death. Sonication is the act of applying sound energy to essay plan, agitate particles in a sample. Ultrasonic frequencies (20 kHz) are usually used, leading to the process also being known as ultrasonication . Sonoporation, or cellular sonication, is the use of these ultrasonic frequencies for modifying the sex marriage, permeability of the cell plasma membrane.

This technique is usually used in molecular biology and non-viral gene therapy in order to allow uptake of large molecules such as DNA into the cell, in degree plan a cell disruption process called transfection or transformation. Sonoporation employs the acoustic cavitation of microbubbles to enhance delivery of such large DNA molecules. Although the early results could achieve only 10- to essays sex marriage debate, 30-fold increases in transfection efficiency in vitro, technical refinements have lead to sectarian violence, enhancements of up to essays on same sex marriage, several thousand fold in vitro ,sufficient to encourage ultrasonication mediated gene transfer in vivo. 1) It is non-invasive and frost fire and ice research well tolerated, 2)extraordinary safety record over a wide range of frequency and intensity. 3)high levels of public acceptability and understanding. there are highly sophisticated, flexible, cost-effective and readily available diagnostic and therapeutic systems that can achieve site-specific transfer of ultrasound energy almost anywhere in on same the body, except perhaps the lung. 4) The bioactivity of this technique is similar to, and in some cases found superior to, electroporation. 5) in vivo is relatively nontoxic.

1)Extended exposure to fire and ice research, low-frequency (MHz) ultrasound has been demonstrated to result in complete cellular death (rupturing) as well as microvascular hemorrhage and disruption of tissue structure, thus cellular viability must also be accounted for when employing this technique. 2) Whether ultrasound affects later steps in sex marriage debate the transfection process, particularly plasmid entry into the nucleus, remains unclear. Sonoporation is under active study for the introduction of bridge creek owl, foreign genes in tissue culture cells, especially mammalian cells. Sonoporation is also being studied for use in targetedGene therapy in vivo, in a medical treatment scenario whereby a patient is given modified DNA, and on same an ultrasonic transducer might target this modified DNA into on same debate, specific regions of the sex marriage, patient’s body. In microinjection DNA can be introduced into cells or protoplast with the help of very fine needles or. glass micropipettes having the diameter of 0.5 to 10 micrometer. The DNA may be directly delivered into the nucleus or in the cytoplasm. Essay? Some of the DNA injected may be taken up by on same the nucleus.

The desired gene in frost and ice research paper the form of debate, plasmid or alone is violence in pakistan, injected directly into the plant protoplast. Injection into the nucleus is more efficient than that into essays on same, the cytoplasm. Micro-injection is carried out essay owl, with automatic equipments (robotics) using a micro-needle. Computerized control of holding pipette, needle, microscope stage and video technology has improved the efficiency of this technique. Advantages of microinjection. 1. Frequency of stable integration of DNA is sex marriage, far better as compare to other methods. 2. Method is effective in transforming primary cells as well as cells in established cultures. 3. Debate? The DNA injected in this process is subjected to essays sex marriage, less extensive modifications. 4. Mere precise integration of recombinant gene in limited copy number can be obtained. 2. Skilled personal required.

3.Has not been successful for many plant cells . 4. Embryonic cells preferred for manipulation. 5. Knowledge of mating timing, oocyte recovery is essential. 6. Method is useful for sectarian violence in pakistan essay, protoplasts and not for essays sex marriage, the walled cells. 7. Process causes random integration. 8. Rearrangement or deletion of host DNA adjacent to site of degree plan, integration are common. 9. The technique is laborious, technically difficult, and limited to the number of cells actually injected. Applications of microinjection. 1. Essays On Same? Process is applicable for plant cell as well as animal cell but more common for animal cells. 2. Creek Occurrence Owl? Technique is ideally useful for essays sex marriage, producing transgenic animal quickly. 3. Procedure is important for gene transfer to embryonic cells.

4. Applied to inject DNA into plant nuclei. 5. Method has been successfully used with cells and protoplast of. tobacco, alfalfa etc. Fig: microinjection in college english essay outline mouse egg. Biolistics or particle bombardment is a physical method that uses accelerated microprojectiles to. deliver DNA or other molecules into intact tissues and on same sex marriage cells. Research? Biolistics transformation is relatively new and novel method amongst the on same, physical methods for artificial transfer of exogenous DNA. Essays Sex Marriage? The nucleic acid is delivered through membrane penetration at a high velocity, usually connected to microprojectiles like microscopic particles of tungsten or gold coated into cells using an electrostatic pulse, air pressure, or gunpowder percussion. As the particles pass through the cell, the DNA becomes free to integrate into the plant-cell genome.

The gene gun is a device that literally fires DNA into target cells . The DNA to essays, be transformed. into the college english, cells is coated onto microscopic beads made of either gold or tungsten. Beads are carefully. coated with DNA. Essays Debate? The coated beads are then attached to the end of the robert fire paper, plastic bullet and loaded into. the firing chamber of the gene gun. An explosive force fires the bullet down the barrel of the gun. towards the target cells that lie just beyond the essays on same debate, end of the barrel.

When the bullet reaches the end of. the barrel it is caught and stopped, but the DNA coated beads continue on toward the target cells. Some of the beads pass through the cell wall into sex marriage debate, the cytoplasm of the target cells. Here the bead and. the DNA dissociate and the cells become transformed. Once inside the target cells, the DNA is. solubilised and may be expressed. 1. Biolistics technique has been used successfully to transform soyabean, cotton, spruce, sugarcane, papaya, corn, sunflower, rice, maize, wheat, 2. Genomes of subcellular organelles have been accessible to genetic. manipulation by biolistic method. 3. Mitochondria of plants and chloroplast of chlamydomonas have been.

4. Method can be applied to filamentous fungi and yeast (mitochondria). 5. The particle gun has also been used with pollen, early stage. embryoids, meristems somatic embryos, plant cells, root section, seeds and pollen. 6. Sex Marriage Debate? This approach has been shown to be effective for transferring transgenes into mammalian cells in vivo . 1. Requirement of protoplast can be avoided. Unlike electroporation and microinjection, this technique does not require protoplasts or even single-cell isolations and creek owl is applicable to even intact plant tissue.

2. Walled intact cells can be penetrated. 3. Manipulation of essays sex marriage debate, genome of subcellular organelles can be achieved. 4. This is also a highly mechanized or robotic mediated technique in which the. speed of the micro-projectile particles is controlled by degree essay plan foolproof mechanisms. 5) It is also gaining in use as a method for transferring DNA construct into whole animals.

6) This technique is fast, simple and safe, and it can transfer genes to a wide variety of tissues. 7)there appears to essays debate, be no limits to the size or number of genes that can be delivered. 1. Do My? Integration is random. 2. Requirement of equipments. 3.It can be a challenge to obtain a sufficient number of sex marriage debate, cells modified by essay this method to see a biologically significant effect. A new technique is presented to debate, incorporate exogeneous gene materials (DNA) into cells with a microbeam irradiation from an uv pulsed laser. A frequency-multiplied Laser, 355 m wavelength, 5 ns pulse duration, punches a self-healing hole of submicrometer aperture in cell membrane under selected irradiation conditions.

At the site of the beam impact, due probably to essay, local temperature changes, the on same sex marriage, cell membrane modifies its permeability. As a consequence of the hit, circular areas, whose radius may be apparently regulated by degree essay changing the irradiation time and/or the radiation intensity (energy), appear on the wall, last for a short time and fade spontaneously . It takes a fraction of a second for the aperture to close, long enough to allow the foreign DNA, contained in essays on same sex marriage the medium, to slip into the cell. It is well established that a strong pressure wave, known as a laser-induced stress wave (LISW), accompanies laser-induced plasma. We have extended their method to deliver macromolecules, such as genes. Plasmid DNA (circular DNA residing in bacterial cytoplasm) is used as a vector of the gene of interest. We inject the plasmid into target tissue, on which a laser target is placed, and subject the target to essays debate, irradiation with a high-intensity, nanosecond laser pulse to induce plasma and hence an LISW.

By placing optically transparent material on the target, the plasma is confined, resulting in an increase in the LISW’s impulse. Interaction of essays on same debate, tissue cells with the LISW allows plasmid to enter the cytoplasm. 1) it only takes advantage of the presence of phenol-red, a normal cell medium component, with no need of addition of extraneous substances; (2) it is a very mild treatment virtually suitable for any cell type and. (3) it allows transfection of selected cells even in paper the presence of cells of different type (providing that they are morphologically distinguishable). 4) . it is rapidly replacing virus mediated techniques as they have serious side effects caused by immune response and limited targeting characteristics rendering them inappropriate for clinical application. 5) The method offers a clear advantage over existing methods: increases the success rate of DNA transfection as well as the efficiency of cell modification by orders of magnitude. 6) . It enables minimally invasive tissue interaction. Thus there are a number of ways by which the genes can be introduced into the cells. With the advent of molecular tools and on same sex marriage technologies it is now comparatively easy to introduce gene into cells without losing its integrity and bridge essay biological activity.

Moreover the recent development in molecular biology has made the transfer of gene with great accuracy to the target cell. The transfer of debate, gene through different gene transfer technologies has cured a number of diseases. Research is on progress to fire paper, cure those diseases which cannot be cured by using drugs. Moreover the treatment of diseases by gene transfer provides better result for a prolong period of time. Essays On Same? It is the need of hour to discover new and cheap method of gene transfer technologies so to make the treatment of the violence essay, diseases a little easier and affordable.

Improvements in gene transfer are required in terms of essays sex marriage, transfection approaches to allow improved transgene uptake efficiencies. 1)Society of Applied Sciences. Gene Transfer Technologies and their Applications: K.H.KHAN. Medical Biotechnology Division, School of Biosciences and Technology, VIT University, Vellore-632014, Tamil Nadu, India. 2)Principles of gene manipulation: R.W.Old ,S.B. Sectarian Essay? Primrose and R.M.Twymann ‘ sixth edition,chapter 10 and 11. 3) BIOTECHNOLOGY 2020-From the Transparent Cell to. the Custom-Designed Process–Prof.

Gerhard Kreysa Dr.-Ing. E.h. Dr.h.c. Dr. R??diger Marquardt. 4) INTRODUCTION TOBIOTECHNOLOGY AND GENETIC ENGINEERING.

5)From genes to genomes- concepts and applications of DNA technology–Jeremy W Dale, Malcom von Schantz. Search our thousands of essays: If this essay isn't quite what you're looking for, why not order your own custom Science essay, dissertation or piece of coursework that answers your exact question? There are UK writers just like me on hand, waiting to essays debate, help you. Do My Paper? Each of us is qualified to a high level in our area of expertise, and we can write you a fully researched, fully referenced complete original answer to on same sex marriage, your essay question. Just complete our simple order form and you could have your customised Science work in paper your email box, in as little as 3 hours. This Science essay was submitted to us by a student in order to debate, help you with your studies. This page has approximately words. If you use part of this page in your own work, you need to outline, provide a citation, as follows: Essay UK, Essay: Gene transfer techniques – pros and cons . Available from: http://www.essay.uk.com/essays/science/essay-gene-transfer-techniques-pros-and-cons/ [04-10-17]. If you are the original author of this content and sex marriage debate no longer wish to have it published on degree essay our website then please click on the link below to request removal:

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45 Biography Templates #038; Examples (Personal, Professional) A biography is simply an account of someone’s life written by another person. A biography can be short in the case of few sentences biography, and it can also be long enough to fill an entire book. The short biographies explain a person’s basic life facts and their importance, but the long biographies would go an extra mile and include more details to make an interesting read. On Same Sex Marriage. You may find yourself in essay, a situation which requires you to sex marriage debate, write a biography of a famous person, a close friend or a relative. For this reason, it pays to paper in india, know how to come up with a biography and essays the important details that you should include in it. The lives of many people have interesting bits of degree essay plan information, but you ought to know what to capture in the biography and sex marriage debate what to leave out. The length of essays on same a biography depends on the type of information that should be included. On Same Sex Marriage. The length will determine the nature of essays on same information and how extensively it will explain the life of on same sex marriage debate a person. For instance, if you are to write a short paragraph about a person it will mostly capture the important details that identify the person compared to a pages-long biography that may even include the person’s childhood experiences and achievements shaping their life. For a short biography, maybe a paragraph or two long, the following details should be captured: A person’s date and place of birth, at times with the date and place of death as may be applicable The person’s major achievements in bridge essay occurrence, life Their educational background and notable awards Work facts of a person and their contribution to that field if any A brief account of the significance of an individual in the community. A lengthy biography will bring out more details of essays on same debate a person’s life making it a bit more complex.

His/her history will be brought out more clearly especially the details that shaped them to be the persons they turned out to be. The target audience will also dictate the do my paper in india nature of the information that is to be included. Essays. The relation of the audience to an individual will have an impact on how the essay occurrence information is presented and the important details that they could be interested in. In a case where the audience is unknown, more details will have to be included. This mostly happens in the case of a several paged biography. You will have to essays sex marriage debate, scrutinize the person in a more detailed way and establish more people relating to the person. Paper. Focusing on the uniqueness of an individual can do wonders in this case and this might turn out to be inspirational to on same sex marriage, many people. The field that the person has majored in or had majored in ought to influence the direction that the biography will take as this will help to paper in india, bring out the contribution of the individual to their field of study. Essays Debate. A biography is meant to analyze a person’s life and interpret it as well.

A good biographer will try to join the dots and degree essay plan explain certain actions and events that a certain figure was involved in. This will help in clearly bringing out the essays sex marriage significance of a person’s life through their accomplishments or remarkable deeds. Biographies are usually written in a chronological order. Some biographers could also draft them in a themed order that is early life, educational background, a person’s achievements or accomplishments. But some especially the robert frost fire and ice short ones will focus on one area in a person’s life. There are several sources of information that could aid one in writing an astounding biography. These sources of information can be grouped into essays on same sex marriage, either primary sources or secondary sources. The primary sources of information include materials like letters, newspaper accounts or diaries. A biographer can also make an english outline, arrangement to interview an individual they want to write about. On Same Sex Marriage Debate. This is also considered as a primary source of information.

The secondary sources are reference books, other biographies or historical records that are related to essays on same, the subject being written about. Select the individual you want to write about Search for the basic facts that relate to a person’s life. The encyclopedia or almanac could be handy at this. Think about the essays on same debate details to add in the biography which can bring out clearly about the person’s life. Sectarian In Pakistan. Choose the on same sex marriage area in a person’s life that you want the biography to revolve around.

Some guiding questions that could aid you in this include; What’s the most interesting bit about the person? What is the significance of the individual to the society and the world in general? What qualities or adjectives will be best suited for the description of the individual? What actions or life events bring out the qualities or adjectives chosen above? What life events or world events shaped the individual or brought out the best in them? Did they face obstacles or take some risks in life?

How did they handle the obstacles and did they happen to be lucky? What impact did they have in the world? Did they add value to the way people view certain aspects of life? Did they come up with a thing, idea or way of action that transformed the paper in india way things are handled or rather done in essays sex marriage, their societies or world in general? Carry out some additional research on the internet to answer some of the questions mentioned above. Ensure that you find information that will help you tell a story that many will love. After getting everything in order, you can proceed to essay, write the biography. We have provided sample biographies in this site that you could check out in order to get the drift.

A biography template is meant to essays debate, specifically aid a writer come up with an excellent biography. For this purpose to be achieved the writer needs to get his/her hands on a high-quality biography template, just like the plan ones provided on this site. The best biography templates should provide clear instructions, and sex marriage this should be in great detail to degree essay, avoid the risk of the writer missing out some important facts. The templates available on this site will help you capture all of the details. The biography templates should also be precise and avoid beating around the bush. Going round one idea or item will make the biography boring to sex marriage debate, read and robert fire research it is prudent for the writer to be straight to the point. By doing this it will be easier for essays sex marriage debate the readers to skim through and find the details they might be interested in frost fire and ice research, with lots of easy. The writer will also save his/her time and concentrate on writing other things. The general sections of essays on same sex marriage debate any biography as outlined by our sample biographies will have; The name of the person A picture of the person An account of their early life The person’s family life The major achievements of the person The three main interesting qualities or facts about the individual. A professional Biography Template. A professional biography is a statement that could either be short or long that is in pakistan essay written about a person, business or company.

It should be engaging, informative and interesting for the readers to identify with the person or business entity being talked about. On Same Debate. It has a sales pitch that is a little bit different. A professional biography template is meant to ease the process of generating printed professional biographies especially for an individual who wants to reach a lot of people or institutions. Elements that should be captured in a professional biography are: A summary of one’s early life in a sentence or two, make it interesting Then information touching on your education, mention any academic awards or the in india clubs and societies that you were part of. Any work experience while in school. Talk about how creative and innovative you are with coming with solutions to the problems that you have faced as an essays sex marriage debate, individual, mention any situation that you were self-reliant in coming up with solutions Mention qualities that make you stand out for do my in india instance, being independent, principled or discerning to increase your trustworthiness. The following tips will enable you to come up with the best professional biography; Be brief and on same sex marriage precise to the point. This is to enable the reader to easily and quickly get to know about college english outline, you. Be spontaneous in your writing Be as expressive as possible and avoid too much of self-editing while drafting the professional biography in the initial stages to capture as much information as possible Be friendly but not too informal Be as interesting as you could in sex marriage, order to get the attention of robert frost research paper many people out there Write it in third person. Talk about your life as if someone else were describing it.

This site offers you a professional biography template that could aid in making the generation of professional biographies an easy and less time consuming task. You can also check out sample bios to figure out how to go about the whole process of coming up with a professional biography. A personal biography is a short account of who you are, your credentials and essays debate your notable accomplishments in life. Personal bios ought to be short, precise and frost and ice research relevant to your target audience. The use of personal statistics such as hobbies or family should be avoided. A personal biography template will help one to easily and conveniently come up with personal bios. The key elements in a personal biography are; Give an introduction of yourself. Remember to write it in essays sex marriage, third person and include the year that your professional career started to be relevant. You could give a list of essay any relevant specializations in your field. State your educational facts and credentials. Mention the degrees that you have pursued and the respective institutions.

Add any relevant experiences you have that are required for your career and mention the name of the society that you are legally a member of. Proceed to outline any notable achievements or awards you have earned in essays on same sex marriage debate, your practice. Remember that the information ought to college english outline, be relevant to the audience being addressed. If you happen to be an author you could mention the magazines or any publishing house that has recognized your works. Your conclusion should mention any upcoming projects or works in progress that people should lookout for on same in the near future.

Don’t forget to mention your current place of residence. As you age, it is good to keep on updating your biography to reflect who you are at violence in pakistan essay present time. You can make use of the personal biography template offered by this site to essays, easily and in a more convenient way generate your own biography without missing out on the important details. We also provide sample biographies to give you a feel of creek essay what your end draft should look like. Essays Debate. If you have kids and you want to let them in on famous historical figures, this site offers biographies for kids.

These will help them know the notable people who help shape the world to english, what it has become to be.

Extracorporeal membrane oxygenation (ECMO) for essays sex marriage critically ill adults in the emergency department: history, current applications, and future directions. © Mosier et al. Creek Essay Owl! 2015. Published: 17 December 2015. Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to essays on same debate, a circuit that pumps blood through an oxygenator and creek owl back into the patient. ECMO has been used for essays on same sex marriage debate decades to violence essay, support cardiopulmonary disease refractory to essays, conventional therapy.

While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and plan cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the essays debate existing literature on the potential use of ECMO in critically ill patients within the emergency department. Extracorporeal life support (ECLS) is a general term used to describe temporary support of cardiac or pulmonary function using mechanical devices. Essays! When using the “heart–lung machine” to completely bypass the essays sex marriage cardiopulmonary circulation, it is referred to as cardiopulmonary bypass. When ECLS is used in the intensive care unit (ICU) or emergency department (ED) to augment oxygenation, ventilation, or cardiac output it is generally referred to as extracorporeal membrane oxygenation (ECMO).

As the science of ECLS has progressed internationally, ECLS use in United States ICUs has increased over 400 % since 2006 [ 1 ]. Violence Essay! This has led to interest in potential earlier applications in the ED, and possibly even the prehospital setting. This review focuses on one modality of essays ECLS, ECMO, and describes the paper in india history of ECMO, common current applications, and important considerations related to ECMO use in adult ED patients. ECLS was initially developed in the 1950s by John Gibbon as a means of oxygenating blood via a membrane oxygenator during prolonged operations on cardiopulmonary bypass [ 2 ]. Given the lack of an open reservoir of blood and extreme anticoagulation required with a traditional cardiopulmonary bypass circuit, ECMO presented a less complex and more sustainable option for treatment of refractory cardiovascular and respiratory failure outside the operating room. Several reports were published demonstrating successful use in essays sex marriage debate, “shock-lung syndrome”, “adult capillary leak syndromes”, and cardiopulmonary failure in the late 1970s [ 3 , 4 ]. In 1979, a randomized controlled trial conducted on adult patients with severe acute respiratory failure reported a 90 % mortality rate for patients in both groups [ 5 ]. Thus, enthusiasm stalled and over the next 30 years ECMO was used mostly for do my paper neonatal and pediatric patients with only a small number of highly specialized centers pursuing ECMO in adult patients. Technological improvements and advances in on same debate, other aspects of critical care have created an ECMO landscape that is very different from the early days of 90 % mortality. For patients with severe hypoxemic respiratory failure, the publication of the Conventional Ventilatory Support versus Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR) trial and several reports of improved survival in patients with acute respiratory distress syndrome (ARDS) treated with ECMO during the H1N1 influenza pandemic have led to a significant expansion of bridge creek occurrence ECMO use [ 6 – 9 ]. Recent data show promise when ECMO is used early in patients with cardiac arrest to on same sex marriage, augment traditional cardiopulmonary resuscitation in the form of extracorporeal cardiopulmonary resuscitation (ECPR) [ 10 – 15 ]. Owl! ECPR may play a role in the prehospital [ 16 ] or ED management of refractory cardiac arrest, cardiovascular collapse due to pulmonary embolism [ 17 ], hypothermia [ 18 ], drowning [ 19 ], overdoses [ 20 ], airway obstruction [ 21 ], and essays sex marriage debate severe electrolyte abnormalities [ 22 ]. Veno-venous ECMO for degree severe acute respiratory failure. Acute respiratory failure due to potentially reversible processes such as ARDS or utilization as a bridge-to-transplant have become the most common indications for ECMO therapy in adults [ 23 ]. It is on same well recognized that positive pressure ventilation can have deleterious effects leading to ventilator-induced lung injury, oxidative stress, and further lung damage. Utilizing ECMO in these patients allows “lung rest” through more protective ventilator settings [ 24 ]. Initial randomized trials of ECMO for respiratory failure did not show a benefit compared with traditional ventilator methods [ 5 , 25 ]. Robert Paper! In the on same sex marriage 1990s and degree essay 2000s, survival rates reported in case series with ECMO improved to on same, 52–75 % [ 26 , 27 ]. On Same Sex Marriage! During the H1N1 pandemic in which patients frequently developed severe ARDS with refractory hypoxemia, patients treated with ECMO showed survival rates as high as 79 % [ 7 , 9 , 28 , 29 ]. The first modern randomized controlled trial of ECMO for adult patients with ARDS, the CESAR trial, was published in 2009. Essays Sex Marriage Debate! It evaluated outcomes in patients with severe ARDS transferred to an ECMO referral center versus patients treated with conventional therapy.

Although mortality at any point was not significantly different, the study identified significantly higher 6-month survival rates in the group transferred to the ECMO referral center—of which only 75 % of the patients received ECMO—versus the control group that were not transferred [ 30 ]. Degree Essay! Thus, it may have been other aspects of care at on same debate the ECMO center, not necessarily the ECMO itself, that led to improved outcomes. The Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome (EOLIA) trial is currently underway, evaluating early ECMO within 3 hours of initiation of mechanical ventilation for patients with refractory hypoxemia and severe ARDS [ 31 ]. If this trial finds a benefit of early ECMO for ARDS, coordinating transfer to ECMO-capable referral centers directly from the ED for creek occurrence owl early initiation of ECMO support may become important for essays on same patient outcomes [ 32 ]. In addition to supporting oxygenation, ECMO may be a beneficial option in patients with hypercapneic respiratory failure that are unable to be managed with mechanical ventilation [ 33 ]. Veno-arterial ECPR for cardiac arrest. Despite advances in management, outcomes for both in-hospital and out-of-hospital cardiac arrest remain poor. In-hospital cardiac arrest treated with conventional cardiopulmonary resuscitation (CPR) typically has a survival rate of 15–17 % and out-of-hospital cardiac arrest (OHCA) survival is frost fire even lower at only 8–10 % [ 34 , 35 ]. The worst outcomes are in patients with prolonged time to essays debate, return of spontaneous circulation. Prolonged cerebral hypoperfusion leads to significantly worse neurologic sequelae and sectarian early initiation of ECPR with veno-arterial (VA) ECMO may be a useful adjunct to essays debate, reducing the interval time from arrest to sex marriage debate, restoration of cerebral perfusion. Data for in-hospital arrest are the sex marriage most promising, likely due to sectarian violence essay, the shorter interval from the onset of arrest to initiation of ECMO flow. Essays On Same Debate! While there are no randomized trials to date, observational studies have reported an fire paper association between ECPR and essays sex marriage debate improved survival. In a retrospective, single-center, propensity-matched analysis, Shin et al. [ 12 ] showed improved survival with favorable neurologic outcome (Glasgow-Pittsburgh Cerebral Performance Category (CPC) score of do my in india 1 or 2) for essays on same sex marriage patients with in-hospital arrest treated with ECPR versus conventional CPR (hazard ratio (HR) 0.17, 95 % confidence interval (CI) 0.04–0.68). Fire And Ice Research Paper! Chen et al. Essays On Same Debate! [ 11 ] found similar 30-day (HR 0.47, 95 % CI 0.28–0.77) and 1-year (HR 0.53, 95 % CI 0.33–0.83) survival for ECPR when compared with conventional CPR.

Both studies indicated improved outcomes when the occurrence owl arrest was of on same debate cardiac origin. Sex Marriage! Another retrospective review of prolonged in-hospital arrests (15 minutes) or refractory shock after return of spontaneous circulation showed nearly half of the patients who survived had a CPC score of 1 or 2 with the use of ECPR [ 10 ]. Essays Debate! Other observational studies have found variable improvements in mortality with the use of robert frost fire research paper ECPR [ 36 , 37 ]. A recent meta-analysis performed by Cardarelli et al. Sex Marriage Debate! [ 38 ] in 135 patients from essay 1990 to 2007 showed a hospital survival rate to discharge with ECPR of on same 40 %. Reports from OHCA studies are not as robust, although there are dramatic reports of college english essay otherwise hopeless cases rescued by essays, ECMO [ 39 ]. Haneya et al. [ 40 ] compared ECPR initiated in the ED for OHCA with ECPR initiated for robert frost fire and ice research paper in-hospital cardiac arrest, and found a survival rate of 42 % for on same in-hospital arrest patients versus only 15 % for OHCA patients. Frost Fire Paper! ECPR combined with therapeutic hypothermia and essays intra-aortic balloon pump placement was recently shown to improve neurologic outcomes for OHCA patients with ventricular fibrillation or pulseless ventricular tachycardia. This study demonstrated survival with a favorable CPC score in frost fire and ice paper, 11.2 % of those with ECPR versus 2.6 % with conventional CPR at 6 months [ 14 ]. Similar results were reported in a small observational pilot study in on same, Australia combining mechanical compression devices, ECPR, and violence hypothermia for patients with refractory cardiac arrest. In this small study, 5 of 11 OHCA patients and essays on same 9 of 15 in-hospital cardiac arrest patients survived, and favorable neurological outcome was achieved in on same debate, half of the survivors [ 15 ]. For witnessed OHCA of cardiac origin, ECPR has shown even greater improvements in neurologically favorable survival (29 % ECPR versus 8.9 % CPR) [ 13 ]. A very promising recent observational study in sex marriage, 26 patients with refractory cardiac arrest, either in-hospital or OHCA, reported a favorable neurological survival rate of do my 54 % when ECPR was combined with a mechanical compression device and therapeutic hypothermia [ 15 ]. However, these data have not been replicated and similar studies have reported survival rates ranging from on same debate 4–15 % [ 41 – 43 ]. Bridge Creek Essay Occurrence! When ECPR can be initiated rapidly, the outcomes for OHCA may be similar to those seen with in-hospital cardiac arrest patients [ 44 , 45 ]. Although there are no large prospective randomized trials and survival from refractory cardiac arrest is poor, ECPR may provide a tool to essays sex marriage debate, improve survival with good neurologic outcomes when initiated early in selected patients. While an optimistic estimate of survival from OHCA with the use of ECPR may be in the 15–20 % range, the critical factor that determines success appears to violence, be the essays sex marriage duration from the onset of degree plan arrest to achieving ECMO flow.

This may be why in-hospital cardiac arrest studies have generally reported better outcomes [ 45 – 47 ]. Furthermore, the volume of debate patients meeting optimal criteria for ECPR, including witnessed ventricular fibrillation/tachycardia with a short interval to initiation of do my in india CPR, refractory arrest despite optimal resuscitative efforts, and 75 years of age comprises a very small (10 %) subset of all patients with OHCA [ 48 , 49 ]. Additionally, complication rates of ECPR remain high [ 43 , 50 , 51 ]. Currently the American Heart Association’s position is essays debate that evidence does not support a recommendation for ECPR, although it may be considered in highly specialized centers in patients who have a potentially reversible disease and a short duration of cardiac arrest [ 52 ]. Bridge Creek Essay Occurrence Owl! The recent Institute of Medicine report on cardiac arrest care states ECMO is an emerging technology that has promise in improving cardiac arrest care and sex marriage should be developed and degree essay researched [ 53 ]. In addition to ECPR, ECMO may have a role in select patients with cardiogenic or septic shock [ 54 – 56 ], toxic ingestions [ 57 ], thyrotoxicosis [ 58 ], or trauma [ 59 ]. Debate! For patients with septic shock, high survival rates may be achievable, although survival rates are significantly diminished in the presence of multi-organ failure and in patients cannulated during cardiac arrest [ 55 , 60 ]. ECMO has shown promising results as a method of do my paper supporting hemodynamics in patients with cardiogenic shock due to acute myocardial infarction [ 61 ], massive pulmonary embolism [ 62 ] or myocarditis [ 63 ]. ECMO may be preferable to aortic balloon pumps as it can provide more robust biventricular support by debate, increasing right ventricular drainage in addition to supporting gas exchange, and it can be employed quickly at the bedside. However, the downside of in pakistan ECMO for cardiac support is that because of the on same sex marriage debate retrograde aortic flow, left ventricular afterload and oxygen demand increase without the placement of a left ventricular drain. ECMO can serve as a bridge to recovery, device implantation, or cardiac transplantation. Do My! Small trials have shown improved survival rates in essays on same debate, patients placed on ECMO as a bridge to a left ventricular assist device and subsequently to transplantation [ 64 ]. Robert Research! Several small studies have shown success in treating cardiogenic shock with ECMO, but there are no data comparing outcomes with ECMO versus alternative rescue modalities [ 65 ]. Arranging the initiation of ECMO may be a viable option in patients with known severe cardiac dysfunction in shock refractory to conventional therapy in the ED. A successful ECLS program requires a significant multidisciplinary and organizational commitment to essays, ensure necessary resources and degree essay plan personnel [ 66 ]. Hospitals with a higher volume of ECLS cases (30 cases/year) have shown improved mortality outcomes compared with hospitals with only a few cases per year (6) [ 67 ]. Initiating ECMO in a critically ill patient requires considerations related to equipment, blood bank capabilities, cannulation configuration, availability of necessary personnel, and coordination with the receiving critical care physicians. In a recent trial evaluating ECMO for OHCA, initiation of ECMO required two critical care physicians for cannulation, a third physician providing ultrasound guidance of cannula placement in the inferior vena cava, a fourth physician dedicated to leading the resuscitation, a nurse coordinator to initiate the sex marriage circuit, and a sixth person to infuse cold saline for intra-arrest hypothermia [ 15 ]. Additionally, while cannulation may be feasible by non-surgeons in the ED [ 68 ], close collaboration with surgeons is imperative due to risks of vascular injury requiring surgical repair. In India! A successful ECLS program requires physicians, nurses, perfusionists, and respiratory therapists trained and competent in cannulation and management of the essays on same debate ECLS circuit to be available in english, sufficient numbers to essays sex marriage, provide 24/7 coverage. A streamlined exit strategy from the ED should be established, whether that includes transfer to the cardiac catheterization lab, ICU, or transfer to degree plan, an ECMO receiving hospital.

Predetermined inclusion and exclusion criteria, as well as guidelines on essays on same sex marriage, how and when to separate from ECMO in a patient who fails to improve are important to optimize outcomes and resource utilization. Finally, when considering initiating ECMO in the ED for creek essay occurrence a particular patient, current inpatient ECMO volume and capacity to accommodate new patients must be considered. On Same Sex Marriage! As a result, ECLS may not be a feasible option at many hospitals due to resource limitations. Paper In India! Local, regional, and inter-regional networks of hospitals with direct communication with the ECMO referral center that provides a mobile rescue team for cannulation and essays sex marriage debate transport of patients with critical cardiopulmonary failure may be the optimal solution to alleviate many of these costly programmatic considerations. Veno-venous cannulation for ARDS. This chest X-ray demonstrates severe airspace disease in a patient with ARDS. The dual-lumen ECMO cannula ( arrows ) can be seen passing through the internal jugular vein, superior vena cava, and terminating in the inferior vena cava at the level of the essays sex marriage hepatic vein. ECMO circuit components and flow. Flow through the ECMO circuit starts with the venous drainage cannula (1), which is propelled forward by essays on same sex marriage debate, the pressure gradient generated by the centrifugal pump head (2). The blood passes through the oxygenator (3) and essays on same sex marriage debate then returns to the patient in essays, the outflow tubing back into the right atrium (VV) or femoral artery (VA) (4).

Gas exchange is regulated by the amount of paper countercurrent “sweep” gas flowing through the oxygenator (5) and the blood is warmed by the thermoregulator attached to the circuit (6). Essays! Flow, hemoglobin, hematocrit and creek occurrence venous saturation can be continuously monitored by ultrasonic meters attached to the circuit (7 and 8) Percutaneous VA ECMO in adults most commonly involves femoral artery and on same sex marriage vein cannulation where oxygenated blood is returned to the femoral artery and flows retrograde into the aorta. Consequently, in the absence of any native cardiac output, VA ECMO provides near complete cardiopulmonary bypass. In the essay presence of on same native cardiac output, blood flow out of the left ventricle mixes with retrograde ECMO return flow in the aorta. If there is no intrapulmonary shunt, the native cardiac output is on same well oxygenated and this mixing is essays sex marriage not detrimental. However, if the degree essay plan patient’s lungs are failing (e.g., because of ARDS), blood flow from the native cardiac output is deoxygenated and essays sex marriage debate competes with retrograde flowing oxygenated blood from the bridge essay ECMO circuit. These competing flows mix somewhere in the aorta and can create differential hypoxemia (“North–south” syndrome) whereby poorly oxygenated blood preferentially perfuses the upper body, including the brain and heart, potentially leading to coronary and sex marriage cerebral ischemia. Contraindications, complications, and ethical challenges. The decision to use ECMO requires a thoughtful risk–benefit evaluation. Contraindications are generally conditions that are known to sectarian in pakistan, be associated with a particularly poor outcome despite ECMO therapy.

Patients with severe neurologic injuries, intracranial hemorrhage, immunosuppression, irreversible multi-organ failure, untreatable malignancy, or those at an advanced age are typically poor ECMO candidates. Patients with aortic dissections or severe aortic regurgitation are not ECMO candidates due to the risks of propagating the essays sex marriage debate dissection and over-distending the sectarian left ventricle, respectively. For patients with ARDS, relative contraindications include prolonged mechanical ventilation that has required injurious airway pressures. For ECPR and cardiogenic shock, patients with unrecoverable heart disease, prolonged arrest time, and those who are non-transplant or ventricular assist device candidates are poor ECMO candidates. If cannulated, these patients are relegated to on same sex marriage, a “bridge-to-nowhere”, which presents a complicated ethical dilemma in essays on same debate, that they cannot survive without ECMO but recovery is essays sex marriage debate improbable and they are not candidates for college english definitive therapy.

Patients generally require anticoagulation while on ECMO and, while it is not an absolute contraindication, an inability to anticoagulate complicates both cannulation and on same long-term management strategies. Complication rates with ECMO are high. Robert Frost Paper! This is on same sex marriage true during both cannulation and ongoing management [ 69 ]. Complications include hemorrhage, stroke, limb ischemia, thrombosis, and infection from the indwelling lines/tubes. Data show at bridge creek essay least one significant complication occurs in over half of patients on ECMO [ 65 ], with bleeding (30–40 %) [ 26 , 51 ] and infection (31 %) [ 51 ] being the most common. Essays On Same Debate! Hemorrhagic complications most commonly occur at the cannulation or surgical sites themselves and are generally related to anti-coagulation, of which VA ECMO requires more aggressive anticoagulation due to the risk of sectarian in pakistan arterial thrombosis. Essays On Same Sex Marriage Debate! VA cannulation carries a high risk of arterial injury—recently reported in 18 % of patients requiring VA ECMO, with most of the injuries requiring surgical repair [ 70 ]. Neurologic complications such as intracranial hemorrhage or infarct are also well-recognized and can be devastating. Other complications include hemolysis, pulmonary edema, and lower extremity ischemia from occlusion of the robert fire research paper arterial flow with placement of the arterial cannula, which can be prevented with the routine placement of an antegrade arterial cannula to that limb. Little is known about long-term complications and essays on same quality of life in adult patients who have undergone ECMO. While there are many anecdotal cases of sectarian essay complete recovery from critical illness in ECMO survivors, some studies report neurologic injury and long-term neurocognitive abnormalities in essays on same debate, over 50 % of cases [ 71 , 72 ]. In addition, ECMO survivors may experience a poor quality of bridge creek occurrence life [ 73 , 74 ], anxiety, depression, and debate post-traumatic stress disorder [ 8 , 74 ]. ICU lengths of on same sex marriage stay tend to be long in essays sex marriage debate, ECMO patients [ 26 , 74 ] and their costs are generally much higher than patients receiving conventional therapy [ 75 ]. The challenges of complications, cost, and resource utilization, when taken together with the potential of on same sex marriage debate creating a bridge-to-nowhere situation for some patients and lack of high-quality evidence, create an ethical obligation to consider the risks and benefits very carefully when considering ECMO in a patient’s treatment plan. Since its advent in essays on same debate, the 1950s, ECLS has gone from the operating room to a promising rescue modality for cardiopulmonary failure in the ICU and beyond.

With expanding potential indications and improving outcomes, there is significant interest in on same debate, the early application of essays on same sex marriage ECMO in the ED, yet significant hurdles still exist. These include lack of definitive data on college english, patient selection, complication rates, functional outcomes and survival as well as resource utilization and economic costs. The H1N1 pandemic, combined with improvements in general critical care, brought modern and essays on same debate improved ECMO technology into the limelight with good outcomes in the treatment of severe acute respiratory failure. College English Outline! Combined with recent data in patients with cardiac arrest and shock that show promising trends, there appears to be potential for on same the early application of ECLS to patients in the ED. Currently, there are no data to support ECMO as anything other than a rescue therapy in experienced centers at this time. Emergency physicians should consider early transfer to do my, a specialized center in debate, the select patients in which ECMO has shown benefit.

Continuing research will likely spur further expansion of ECMO with increased utilization occurring in the ED and possibly even the prehospital setting. However, we encourage a cautious and evidence-based approach to future applications of college english ECMO prior to widespread adoption given the logistical and ethical challenges of this technology that has the sex marriage debate potential to outpace the supporting data. Acute respiratory distress syndrome. Conventional Ventilatory Support versus Extracoporeal Membrane Oxygenation for Severe Adult Respiratory Failure. Cerebral Performance Category. Extracorporeal life support. Extracorporeal membrane oxygenation. Extracorporeal cardiopulmonary resuscitation. Intensive care unit. Out-of-hospital cardiac arrest.

Open Access This article is english essay outline distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and essays on same debate reproduction in any medium, provided you give appropriate credit to the original author(s) and frost paper the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to essays debate, the data made available in this article, unless otherwise stated. The authors declare that they have no competing interests. All authors contributed to english essay, the literature review, manuscript preparation and approval of the final draft. J.M.M. is a dual-trained physician in emergency medicine and critical care and associate medical director of adult ECMO services at the University of Arizona. He is debate a member of the Arizona Emergency Medicine Research Center and the Arizona Respiratory Center. C.D.H. is a dual-trained physician in fire and ice, emergency medicine and critical care at the University of on same Arizona. Debate! S.P.W. is a dual-trained physician in emergency medicine and critical care at the University of Michigan.

K.J.G. is an on same sex marriage associate professor of emergency medicine, internal medicine, and anesthesiology at the University of Michigan. He serves as the chief of the division of emergency critical care, medical director of the emergency critical care center, intensivist in the Cardiovascular ICU, and a core investigator in debate, the Michigan Center for Integrative Research in Critical Care (MCIRCC). Y.R. is the medical director of adult ECMO services at the University of essays Arizona. R.M. is the medical director of the pediatric ICU and ECMO services at the University of Arizona. Creek Owl! D.W.S. is a Professor and Distinguished Chair of Emergency Medicine, Co-Director of Emergency Medical Systems Research and sex marriage debate the Associate Director of the bridge creek owl Arizona Emergency Medicine Research Center at the University of on same debate Arizona. Sauer CM, Yuh DD, Bonde P. Extracorporeal membrane oxygenation use has increased by in pakistan, 433 % in essays on same, adults in the United States from 2006 to 2011.

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