Nina Zeh

Home Institution
Universität Rostock

Host Institution
University of California, San Diego
Mentors: Tarek Hassanein, M.D., Chief of Clinical Hepatology, Division of Gastroenterology; Steven Rossi, Ph.D., Department of Anesthesiology; Lee Hagey, Ph.D., Division of Gastroenterology; Alan Hofmann, Ph.D., Division of Gastroenterology

E-Mail
nina.zeh@web.de

Research Topic
see Abstract
Personal Reactions to the U.S. Experience
After a great week of introduction in Maine, I became one of the many unfortunate people who found themselves stuck elsewhere due to the events that took place on September 11. I have never felt so lost before. The airport was evacuated and I was unable to find anyone who could offer any means of help. Eventually I found two girls who provided me with a place to stay, allowing me to survive such a frightful week. After I arrived in San Diego, my stay turned out to be better each day. It was an outstanding experience being able to work with people from multiple departments while perform-ing various duties. My work included being in the lab, joining rounds with other labs, and participating in the rounds and Grand Rounds of the Hillcrest Medical Center. I even went to the Research Division of the San Diego Zoo to learn something about anesthesia in wild life. It is true: it never rains in California. There are a huge variety of outdoor activities offered in "Sun" Diego. Within two hours you can either go to the desert or skiing in the mountains. Furthermore, you will find remarkable cultural diversity. It is sometimes more important to speak Spanish than English. For me, the most surprising fact was that there were many more differences between Europe and the US than I thought before. I was faced with more rules and with less freedom.
Greatest Difficulties Encountered
Even though I had a nice place to stay and really helpful people around me from the start, it was pretty difficult to get settled here. Buying a car that actually ran, taking the necessary tests at the DMV, finding the appropriate insurance, and getting a Social Security number, were all things that sometimes turned out to be much more of a difficult challenge than expected.
Most humorous incident
The week after September 11, I was stuck in a motel room with two American girls twenty miles away from Washington, D.C. Because of the tragedy we didn't have much to laugh about, but sometimes we had a nice time together, mostly due to my language difficulties. I remember once when Heidi, which, by the way, is a common name for Americans, told me about freckles. I had no idea what she meant by that, so she explained it to me and I thought she was talking about spots. When she mentioned that she liked her friend's freckles so much, I got really confused and slightly embarrassed. It took us a while to solve the problem and we had a great laugh.
Helpful Hints for Future Students
- Try to find a place to live before arriving in San Diego. It would be even better if you could get an apartment together with a roommate. This is a great way to learn more about the cultural habits and all the multiple differences there might be.
- You will need a car in San Diego, as there exists no efficient public transportation system. Also see www.roommatesservice.com, www.sdreader.com, www.autotrader.com, www.ucsd.edu, This can make things much easier in the beginning.
- Avoid the DMV as much as you can. It is really an annoying place. However, if you have to take the written test for the California driver's license, read the handbook first!
- Be careful with cactuses in the Joshua Tree National Park. They will jump on you!
- Don't walk across the street without a pedestrian light in Pacific Beach at night. You might get a ticket for it.
- Don't forget, by getting stuck in the lab, that you have this unique opportunity to visit other BMEP students spread all over the US. Take this chance to see as much of this huge country as you can.

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Abstract on Research Topic:
Effect of Molecular Adsorbent Recirculating System (MARS) on Plasma Phospholipid Fatty Acid Levels in Patients with End Stage Liver Disease Complicated by Hepatic Encephalopathy
Institution at which research was done:
University of California, San Diego; Department of Medicine
Introduction:
In patients with End Stage Liver Disease (ESLD) a possible complication is hepatic encephalopathy. Previous studies have shown that ESLD is associated with a decrease in plasma phospholipid fatty acid levels. Albumin dialysis using the Molecular Adsorbent Recirculating System (MARS) has been effective in removing toxic molecules accumulating in patients with liver dysfunction and contributes to clinical improvement in liver failure.
Purpose:
To determine the effect of MARS on the plasma phospholipid fatty acid levels in patients with ESLD who also had hepatic encephalopathy.
Materials and Methods:
Plasma samples of patients on standard medical therapy (SMT) versus patients who received MARS in addition to standard medical therapy were obtained over a five day period. In order to establish a normal range of plasma fatty acid levels, control subjects with no evidence of liver disease were analyzed. For the plasma lipid extraction a modified Folch Method was used. Plasma phospholipid fatty acid composition was determined by capillary gas chromatography.

Results:
We found lower levels of very long chain polyunsaturated fatty acids in patients with end stage liver disease compared with controls. Particularly arachidonic acid (AA) and docosahexaenoic acid (DHA) levels are decreased in plasma phospholipids in patients with end stage liver disease. Additionally we found reduced levels of total plasma lipids in these patients. In patients who received SMT only, if their hepatic encephalopathy did not improve, they continued to have decreased plasma levels. In those patients who received MARS treatments, there was a change in their decreased plasma levels after receiving between 2 to 5 six hour treatments with the MARS device.

Conclusion:
Preliminary results suggest that there is an effect of using albumin dialysis (MARS) in patients with hepatic encephalopathy, however, the pathophysiological function is not known. AA and DHA play a major role in neuronal membrane function which should be further investigated in patients with ESLD being treated with the MARS machine.

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