Hello, my name is Chris pilot and this past year I was lucky enough to study the effect of cardiac surgery on microparticles production. While I was interning down at the myocardial biology and her research lab this past academic year. So cardiac surgery has known systemic inflammatory response. And this syndrome is thought to be caused by cardiopulmonary bypass causing initiating factors due to the ischemia. And this activates the immune system and produces our systemic inflammatory response. And way how to measure this would be to see the amount of metal particles that are in the blood plasma. So microparticles, given their name or small, in fact, there is 0.1 to 1 micrometers. And they're formed via cell activation in apoptosis. And they've been indicated the play roles in, among other things, information. So one of the things to try to find this connection between why studying microparticles and cardiovascular disease is that there is a noted pair couldn't hypothesis of cardiac progenitor cells in which microparticles have been implicated to possibly affect improved heart function via direct differentiation. And understanding this and finding some value that could be used for therapies is very important, especially in terms of figuring out how Michael particles could help with addressing the dysregulation of signal transduction pathways, as well as the defective function of membrane proteins associated with the harsh. So the best cardiac surgery to study in regards to microparticles production would be the elective surgery of coronary artery bypass grafting, in which the patient zone greats fan as vein is allograft in around the heart to diverge away from the blocked coronary artery, the one that provides the heart with oxygen rich blood. This requires pulmonary bypass, but some elective surgery. So it's kind of an ideal one to study in terms of not having any kind of implications of say, if it was a more emergent surgery, say like someone that was undergoing cardiac arrest or Myra myocardial infarction. And it's interesting because this is where the basis of my hypothesis for this study comes from. It's that cardiac surgery will cause an increase in microparticles production. And we can know the white blood cells are found normally within the blood at levels of 2 thousand to 10 thousand per micro liter. So using some of the most recent studies, one done by robots at all, published just this past March, shows that there is an increase outside of that normal range of white blood cells 48 hours after the cardiopulmonary bypass surgery. Furthermore, we can see that interleukin six, a cytokine, has pleiotropic effect. Roe start of the systemic inflammatory response also has an increase from 0 scene at the surgery all the way up to about level of 0.2 nanograms per milliliter, indicative of the systemic inflammatory response that I want to elucidate and enumerate further zone in terms of the cohort size, it was a total of 41 patients all having the elective cabbage surgery. And the blood plasma samples of five time points were evaluated for micro-particles. These include pre operation during surgery for eight hours post operation, in 24 hours post operation and for days post operation. And then in order to find some clinical correlations, they permeate the demographics of age, gender, body mass index, cardiopulmonary bypass time, HBA1C percentage, as well as diabetes mellitus and insulin were correlated. So in terms of the actual number of micro-particles produced, there were established control of sigma and micro beads in which to test tubes per patient had a unfiltered filtered and control. And the actual value of micro-particles per microliter were found by taking the unfiltered minus the control, finding that value and then minusing that by default there minus to control to give us an actual value for the micro-particles per micro liter blood. And this can be seen from the data collected from the flow cytometry as seen in the control example in a test tube example. So they're correlating gates and what they mean, what they measure. So in terms of overall production for overall levels, overall levels of micro particles, we can see that there is a decrease after the cardiac surgery. So normal base level, preoperative level of around about 15 seen a significant decrease down to around about 12, that increases roughly about 13 levels off around about 14. Going through those sequential time points. As such, there was the Freedmen's test, which is a non-parametric statistical test which is used to detect the differences and treatments across multiple tests attempts. There were two trials, two iterations for each time point per patient done. So this would involve ranking each row together and then considering the values, brands of each column, as well as using the Dan's Multiple Comparison Test, in which the difference in the sum of ranks between the two columns for the expected average difference, I'll give a statistically significant value given those differences. So as such, we can see basically each time point had its own signif, significant difference compared to preoperative weapons. One of the more, kind of the interesting parts of the results of the clinical correlations were that the number of micro-particles does not correlate it to the level of glycated hemoglobin. This is for all five time points. As such, they're Watson statistical significance found between the post operative time points for a decrease in the micro particles produced given a longer duration of cardiopulmonary bypass surgery. So in conclusion, the number of circling microparticles has significantly decreased during cardiac surgery and the acute inflammatory phase after the cardiopulmonary or cardio artery coronary artery bypass grafting surgery and returns the preoperational levels within four days. In terms of follow-ups for this study, I think characterizing the subpopulations of a micro-particles would be a next best step, as well as maybe seeing if there's anything significant, just you a coronary artery bypass grafting surgery by comparing to other different surgeries, that of heart transplantation and heart septal defect. We're Paris to see if it is true with the idea that cardiopulmonary bypass is the step that causes the initiating factors to cause the systemic inflammatory response syndrome. As such, I wish to acknowledge all the people here on this slide, all those within the myocardium biology and Heart Failure Research Lab. And all of those and the cardiovascular research clinical group of those in the flow cytometry, corn, and those that are the organizers of this University Southern Maine and Maine Medical Center Research Institute internship. Thank you for listening. If you have a great day.