Our students’ summer contributions to the lab

It’s time for a well overdue thank you to all of our student volunteers for their contributions to the lab over the summer.  This year, instead of offering standard work experience to two or three students, as we have done in the past, we decided to ask our Student Panel members for help with a number of tasks that would be beneficial to both them and us.  An experimental approach but it worked even better than we had hoped!  So, many thanks to:

Lottricia Millett, Lily Groom, Morgan Walker, Reef Ronel, David Launer, Casril Liebert and Ashleigh Francis for writing summaries of published research papers from the lab.  All of these summaries (which were of a very high quality!) are published here on the blog as well as being displayed in the patient waiting area of the department.  A number of them have also been sent out to the patients and healthy volunteers who took part in those studies to inform them of the findings of the research to which they contributed.  Feeding back results of studies to participants is really important, and it’s great to be able to send these summaries out to people. 14222263_1788954434721939_5703414665885109122_n We also hope that the students will be able to use these summaries to demonstrate their skills when attending for university interviews and suchlike.

Kiki14088424_1787637261520323_4645596235687183587_n Riad-Forbes and Banke Faboyede for revamping the display board in our patient waiting area.  The display has photos of the researchers in the department and information about the different types of research everyone does, plus links to this blog and our Facebook & Twitter accounts.  We see a lot of people reading the information while they’re waiting so the eye-catching display is definitely doing its job!

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13906611_1778805805736802_1603152345208128348_nMiki Friend, Asha Omar, 14045962_1784058648544851_3183321450250707211_nKiki Riad-Forbes, Banke Faboyede and Muska Yarzi for putting together a database of all of Alan and Vicky’s previous research participants and sending a huge mailshot to them all with the summaries of the studies for which they volunteered.  This wasn’t the most interesting of jobs, involving lots of typing, printing, sorting piles of paper, and stuffing envelopes but was a task that probably just wouldn’t have happened otherwise.  After some delays with a new postal system at King’s we’ve just sent out 216 A4 envelopes, with a few more to go out in due course.

Neta Fibeesh, Abi Mincer and Ma’ayan Dee, for writing a summary of Arietta Spinou’s PhD thesis studies, which again will be sent out to her patient participants to inform them of the outcome of the research.  The nature of Arietta’s research is a bit different to the types of studies that most people are familiar with, so Neta, Abi and Ma’ayan did very well to summarise these studies in a way that’s accessible to people with no scientific background.

Ibtissam Adem and Deeqa Mohamed, for producing a great video of the SkinSuit study being undertaken at the KCL London Bridge campus with PhD student Phil Carvil and MSc student Alex Sehgal under Ged’s supervision.  Not only did they film it in 13892088_1778805789070137_4994973215050727729_ngreat detail, they took a lot of time to ensure they understood all of the complex science of both the suit (designed to mimic the some of the effects of gravity when astronauts are in space) and the measurements being made.  The video will be a great resource for a lot of people.

So we think that’s a pretty decent summer of work!  It has been wonderful to partner with our Student Panel members and we have been very impressed with the quality of the work they’ve all produced.  We’re already looking forward to what achievements next summer will bring!

Research summary – Morgan Walker

Airways Obstruction and Pulmonary Capillary Blood Volume in Children With Sickle Cell Disease

Catherine Wedderburn, David Rees, Susan Height, Moira Dick, Gerrard F. Rafferty, Alan Lunt, Anne Greenough

Published in the journal Pediatric Pulmonology, published online July 10th 2013

Children with Sickle Cell Disease (SCD) often face many obstacles due to the changes the condition causes in the body’s red blood cells. SCD results in anaemia, which is when there is less haemoglobin in the blood to help carry oxygen around the body. As a result, the heart has to pump much harder in order to ensure that the tissues of the body receive enough oxygen. This increased work by the heart also raises the amount of blood in the lungs, in order to allow sufficient oxygen is absorbed from the air. Children with SCD also frequently experience ‘airway obstruction’, which is the narrowing of the airways that makes it then harder to breathe. Airway narrowing can be caused by asthma, where muscles in the airways constrict, or by other causes.

This research was used to investigate whether the increased blood volume in lungs is associated with the ‘obstruction’ of the airways. The researchers tested this through testing the difference in the airways before and 30 minutes after using a medication called a bronchodilator (the blue asthma ‘reliever’ inhaler) which relaxes the airway muscles, widening the airways.   The study used measurements called spirometry, which tests the amount and speed of air that can be moved in and out of the lungs, and Impulse Oscillometry (IOS), which uses sound waves in order to assess the resistance of the airways (airway narrowing).

If the bronchodilator had a substantial effect, the researchers would be able to say that the airway obstruction was due to an asthma-type condition, as the inhaler would have relaxed the muscles and allowed air to move more easily through the airways. What the results showed, however, was that there was little change in the measurements of lung function after the inhaler was given. The researchers can therefore use this evidence to support the hypothesis that the airway obstruction in SCD may be due to increased blood volume in the lungs.

Therefore, this study suggests that treatment of non-asthma related airway obstruction in SCD patients could perhaps move away from bronchodilators and towards more effective treatments for the anaemia aspect of SCD such as blood transfusions. A great deal of further work is needed but this is a valuable insight into the a potential process underlying breathing problems in SCD.

This summary was produced by Morgan Walker, Year 13 student from Harris City Academy Crystal Palace, as part of our departmental educational outreach programme.

Research summary – Reef Ronel

Neuromuscular electrical stimulation to improve exercise capacity in patients with severe COPD: a randomised double-blind, placebo-controlled trial

Matthew Maddocks, Claire M. Nolan, William D-C. Man, Michael I. Polkey, Nicholas Hart, Wei Gao, Gerrard F. Rafferty, John Moxham, Irene J. Higginson

Published in the journal Lancet Respiratory Medicine, published online December 14th 2015

Patients with severe COPD often have weak legs as breathlessness can limit their ability to be active. Normally, to combat this and other symptoms of COPD, exercise classes called Pulmonary Rehabilitation (PR) are carried out. However, more severely affected patients may struggle to do PR.

An alternative therapy was introduced, neuromuscular electrical stimulation (NMES), to COPD patients with more severe symptoms. NMES is when electricity is used to create muscle contractions, in this case in the thigh muscles. While NMES has been used to strengthen muscles in previous research, this trial is the first to explore the impact on daily activities and the first to investigate the longer-term impact of the treatment.

52 participants with very severe COPD took part in this trial over two years. Participants received 30 minutes of NMES to both sets of thigh muscles daily for 6 weeks; 27 were placebo (‘sham’ stimulation) and 25 received active NMES. The aim: to assess the effectiveness of NMES, as a therapy to be conducted unsupervised at home, and at aiding daily activities. The main measure of effectiveness in this trial was a test of how far participants could walk in 6 minutes.

The results of the walk tests strongly support the use of NMES for severe COPD patients, with the patients who received the active NMES being able to walk substantially further. During interviews active NMES participants expressed a greater ease in everyday tasks (such as climbing the stairs) and stated that they could carry out physical activities for longer. No participants reported any negative views. Unfortunately, the improvement provided by NMES quickly waned after the treatment had stopped. Therefore, all existing evidence suggests that NMES should not be considered a replacement for PR. NMES can be used as an extension to PR, and could be used when patients are unable to take part in PR programmes. In addition, the short duration of effect suggests that longer programmes need to be investigated. Nonetheless, this trial has shown that NMES is a practical home-based therapy, suited to patients with more severe symptoms and has gives suggestions for future research.

This summary was produced by Reef Ronel, Year 12 student from JFS School, as part of our departmental educational outreach programme.

Chris starts his study

Chris Harris, one of our neonatal research colleagues, has recently started measuring patients for his major study comparing the effects of two types of ventilation for babies born prematurely.  The United Kingdom Oscillation Study started in 1998 and recruited over 300 babies who were born 12-17 weeks early and needed help with their breathing from a ventilator.  All of the babies were given one of two types of breathing support – normal ventilation, where air is pushed into the lungs at a rate and depth about the same as they would do on their own, or ‘high-frequency oscillation ventilation’ or HFOV, where the lungs are inflated and then small amounts of air vibrated, or oscillated, in and out of the lungs at a very fast rate.  The idea of the HFOV is that it doesn’t involve the same amount of stretch to the lungs as normal ventilation, possibly preventing some of the damage that can occur to premature babies’ delicate lungs during the crucial weeks after birth while so much lung growth and development is taking place.  Chris is also doing some cellular biology as part of his PhD, stretching lung cells in the lab and seeing what inflammatory chemicals are released.  This will help give a more complete picture of why HFOV may (or may not) be beneficial.

The UKOS participants were last studied at 11-14 years of age; the results then showed that HFOV seemed to have protected the lungs somewhat, particularly the smaller airways further down in the lungs.  These airways are particularly prone to damage as they are still forming during the stage at which these babies were born, and the HFOV perhaps allowed those parts of the lung to continue developing more normally, as they would have done were the babies still in the womb.

The current stage of the research will make detailed lung function measurements again in as many of the participants who are able to come back for more testing, and again compare the children who received HFOV to those who received normal ventilator support.  The UKOS “babies” are now young adults, aged 16-18, and so have probably grown a huge amount since their last tests; this growth will have affected their lung function so that’s why it’s important to see how they’re getting on now.  Chris has had four patients participate so far and all has gone well thanks to their brilliant efforts, so we’re looking forward to seeing the data come in!