Editor's Choice
This quarter the British Medical Bulletin has another excellent varied set of reviews in topics which are new or unusual in emphasis.
At a time when the Olympics are much in the news, our first review is on Updates on improvement of human athletic performance: focus on world records in athletics by Lippi, Banfi, Favaloro, Rittweger and Maffulli from Verona and Milan in Italy, Manchester Metropolitan University and Keele University in the UK (page 7).
Their review states that the progression of world records in athletics is considered a reliable means to assess the potentiality of the human body, and also reflects how society has evolved over time and will continue to evolve. They conducted a quantitative analysis of world records in measurable Olympic events from nine representative disciplines (100 m, 400 m, 1500 m, 10 000 m, marathon, long jump, high jump, shot-put and javelin throw). Data were gathered for the years 1900–2007 from the database of the International Olympic Committee.
Overall, the relative improvement of athletic performance was higher in women than in men, being nearly doubled across the different disciplines. The biggest increases were observed for javelin throw and shot-put, in both men and women. Improvements in race times were directly related to the race distance. They also observed a significant linear model of world record progression with time, although the improvement has substantially stopped or reached a plateau in several specialities. The observed trend might be explained by a variety of factors, including social and environmental changes, natural selection, advances in training and sport physiology, ergogenic aids and, possibly, drug-taking. These results are discussed taking into account several biological, environmental and technological issues that might explain the trends observed.
Next, we have a review on the Genetics of inflammatory bowel disease (IBD): clues to pathogenesis by Zhang, Massey, Tremelling and Parkes from Cambridge University (page 17).
They make the point that it has long been recognized from epidemiological data that the inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis, have a strong genetic predisposition, interacting with unknown environmental drivers to render individuals at risk for relapsing intestinal inflammation. Substantial progress has been made in the last 2 years in characterizing the genes involved. A recent acceleration in understanding has resulted from the use of the new technologies of genome-wide association scanning in large panels of cases and controls. Using genome scans, these have shown that there are 11 susceptibility genes and loci and highlighted a number of new, previously unsuspected pathways as playing an important role in IBD pathogenesis, including the IL23 pathway in IBD overall and specific aspects of innate immunity in Crohn's disease.
The next challenge is to identify specific causal variants at each of the confirmed susceptibility loci and then characterize their biological impact on gene expression and function of the protein product. To date, most attention has focused on Crohn's disease. A recent meta-analysis has increased the number of confirmed susceptibility loci to 32—more than for any other common disease to date. Attention is now turning to use of the same techniques in ulcerative colitis, to identify new, disease-specific genes and understand areas of overlap.
The next review is on Myocardial tissue engineering (MTE) by Jawad, Lyon, Harding, Ali and Boccaccini from Imperial College, London (page 31).
They show that regeneration of the infarcted myocardium after a heart attack is one of the most challenging aspects in tissue engineering. Suitable cell sources and optimized biocompatible materials must be identified. In their review, they briefly discuss the current therapeutic options available to patients with heart failure post myocardial infarction. They describe the various strategies currently proposed to encourage myocardial regeneration, with a focus on the achievements in myocardial tissue engineering (MTE). They also report on the current cell types, materials and methods being investigated for developing a tissue-engineered myocardial construct.
Generally, there is agreement that a ‘vehicle’ is required to transport cells to the infarcted heart to help myocardial repair and regeneration. However, a suitable cell source, biomaterials, cell environment and implantation time post-infarction remain obstacles in the field of MTE. Research is currently being focused on optimizing natural and synthetic biomaterials for tissue engineering. The type of cell and its origin (autologous or derived from embryonic stem cells), cell density and method of cell delivery are being explored. The possibility is also being explored that materials may not only act as a support for the delivered cell implants, but may also add value by changing cell survival, maturation or integration, or by prevention of mechanical and electrical remodelling of the failing heart.
The next review is on The immunodeficiency of chronic lymphocytic leukaemia (CLL) by Hamblin and Hamblin from the University of Southampton, UK (page 49).
They state that patients with chronic lymphocytic leukaemia (CLL) have progressive immunodeficiency. Their review seeks to identify the extent of the abnormality, its cause, clinical significance and any possible remedy. The immunodeficiency chiefly manifests as hypogammaglobulinaemia but involves all elements of the immune system. It is caused by the interpolation of tumour cells among immunological cells and mediated by bi-directional cell contact and secretion of cytokines, which both sustain and invigorate the tumour and suppress the immunity.
CLL treatment generally makes the immunodeficiency worse. Intravenous immunoglobulin is clinically effective but not cost-effective, whereas prophylactic antibiotics are useful in appropriate circumstances. Vaccination against infectious disease is usually ineffective, and the improvement of responses remains an area of investigation. Infection is the most important cause of death in CLL and strategies to improve immunity are urgently needed.
The next review is on The social behaviours of bacterial pathogens by Popat, Crusz and Diggle from the University of Nottingham (page 63).
The term quorum sensing (QS) is used to describe communication between bacterial cells, whereby a co-ordinated population response is controlled by diffusible signal molecules produced by individuals. Studies on QS-mediated signalling processes in bacteria have revealed the existence of intricate regulatory networks to enable bacterial populations to fine tune their responses to environmental changes and increase their chances of survival, using complex signalling pathways.
A population of bacteria invading a host may benefit from the coordinated release of virulence determinants and in vitro studies have shown that QS regulates virulence factor production in many species of bacteria. However, the role of QS in vivo is less well understood, but has been demonstrated to be important in several pathogenic organisms. There is a growing interest in blocking bacterial cell–cell communication as a means to control infections. This review discusses QS from a pathogenic perspective and the potential of QS as an anti-pathogenic target.
There follows a review on Articular cartilage: structure, injuries and review of management by Abhijit, Bhosale and Richardson from the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust in Oswestry in the UK (page 77).
Articular cartilage provides an ultimate low-friction gliding surface, which none of the artificial constructs have been able to replace successfully. A retrospective review of knee arthroscopies has revealed an underestimated incidence of this complex problem. Cartilage injuries in the knee joint if left untreated lead to premature arthritis and affect people's activities of daily living. Various different treatment methods of cartilage regeneration have shown encouraging results, but unfortunately none has proved to be the ultimate solution.
Great debate still persists about the best available treatment for symptomatic chondral or osteochondral defects. Several authors have reported good results with different techniques; however, none has proved to be the solution for the problem. Up until 1990, marrow stimulation techniques were a routine form of management for chondral defects. However, ever since autologous chondrocyte implantation was successfully introduced in humans, it has provided a new dimension for the treatment of chondral defects. New minimally invasive techniques are being invented, but the success of any treatment lies in its longevity. Timely research, based on randomized controlled trial comparing different methods of cartilage reconstruction, is necessary for decision-making in today's evidence-based medical world.
The next review relates to Targeted therapies in pancreatic cancer by Danovi and Lemoine from Barts and The London and Queen Mary University in London (page 97).
Pancreatic cancer is a devastating malignancy and a leading cause of cancer mortality. Furthermore, early diagnosis represents a serious hurdle for clinicians as symptoms are non-specific and usually manifest in advanced, treatment-resistant stages of the disease. This review looks at the rationale and progress of targeted therapies currently under investigation. At present, chemoradiation regimes are administered palliatively, and produce only marginal survival benefits, underscoring a desperate need for more effective treatment modalities.
Questions have been raised as to whether erlotinib, the only targeted therapy to attain a statistically significant increase in median survival, is cost-effective. The last decade of research has provided us with a wealth of information regarding the molecular nature of pancreatic cancer, leading to the identification of signalling pathways and their respective components which are critical for the maintenance of the malignant phenotype. These proteins thus represent ideal targets for novel molecular therapies which embody an urgently needed novel treatment strategy.
The next review is on Rating systems for evaluation of the elbow by Longo, Franceschi, Loppini, Maffulli and Denaro from Rome, Italy and Keele University, Stoke on Trent (page 131).
Many scoring systems have been used for elbow disorders. However, only a few of these have been validated, and many assess only some aspects of elbow function. A literature search was performed using as keywords ‘elbow’ in combination with ‘scoring system’, ‘outcome assessment’, ‘elbow disorder’ and ‘clinical evaluation’. Currently, 18 scoring systems are available for the evaluation of elbow disorders. Each of them evaluates the elbow performance using specific variables, including both objective and subjective criteria. All these scoring systems are presented in their extensive form.
Although many scoring systems have been used, we are still far from a single outcome evaluation system which is reliable, valid and sensitive to changes of clinical importance; which takes into account both patients' and physicians' perspective and which is short and practical to use. Further studies are required to evaluate the reliability, validity and sensitivity of the elbow scoring systems used in the common clinical practice.
The next review is on a most important topic Visual function and fitness to drive by Kotecha, Spratt and Viswanathan from the City University Moorfields Eye Hospital and the Royal Free Hospital in London, UK (page 163).
Driving is recognized to be a visually intensive task and accordingly there is a legal minimum standard of vision required of all motorists. The purpose of the review is to explore the current UK visual requirements for driving and discuss the evidence base behind these legal rules. The role of newer, alternative tests of visual function that may be better indicators of driving safety will also be considered. Finally, the implications of ageing on driving ability are discussed.
A search of Medline and PubMed databases was performed using the keywords driving, vision, visual function, fitness to drive and ageing. In addition, papers from the Department of Transport website and UK Royal College of Ophthalmologists guidelines were studied. Although the evidence suggests that the current UK visual standards for driving are based upon sound scientific evidence, advances in technology have brought about more sophisticated methods for assessing the status of the binocular visual field and examining visual attention. These tests appear to be better predictors of driving performance. Further work is required to establish whether these newer tests should be incorporated in the current UK visual standards when examining an individual's fitness to drive.
The last review in this edition is about the Current use of antiretroviral treatment by Bailey and Fisher from Brighton and Sussex University Hospitals NHS Trust, UK (page 175).
They make the point that antiretroviral therapy for HIV infection has transformed it from a terminal illness to a chronic manageable condition. This review summarizes the history of the treatment and explains current practice in the field, including its uses in prevention strategies. They examine national and international guidelines, important publications in peer reviewed literature and recent important conference abstracts.
There is a broad agreement on the choice of drug regimens and on the need to treat patients with symptomatic HIV infection and with CD4 cell counts less than 350 cells/mm3. The need to adapt therapy to individual circumstances is also well accepted, e.g. hepatitis co-infection and pregnancy. Treatment of acute HIV infection and the optimum time to commence therapy in asymptomatic chronic infection remain controversial. The use of anti-retrovirals for prevention, e.g. pre-exposure and post-exposure prophylaxis, is still developing. New strategies for using current drugs, the best use of newly available drugs and new uses of antiretroviral drugs such as in the prevention of HIV transmission are key areas for research. Further research addressing the question of when to start antiretrovirals and assessing their long-term effects is also needed.
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in BMB:
- Updates on improvement of human athletic performance: focus on world records in athletics
- Giuseppe Lippi, Giuseppe Banfi, Emmanuel J. Favaloro, Joern Rittweger, and Nicola Maffulli
BMB 2008 87: 7-15.[Abstract] [FREE Full Text] - Genetics of inflammatory bowel disease: clues to pathogenesis
- Hu Zhang, Dunecan Massey, Mark Tremelling, and Miles Parkes
BMB 2008 87: 17-30.[Abstract] [FREE Full Text] - Myocardial tissue engineering
- Hedeer Jawad, Alex R. Lyon, Sian E. Harding, Nadire N. Ali, and Aldo R. Boccaccini
BMB 2008 87: 31-47.[Abstract] [FREE Full Text] - The immunodeficiency of chronic lymphocytic leukaemia
- A. D. Hamblin and T. J. Hamblin
BMB 2008 87: 49-62.[Abstract] [FREE Full Text] - The social behaviours of bacterial pathogens
- Roman Popat, Shanika A. Crusz, and Stephen P. Diggle
BMB 2008 87: 63-75.[Abstract] [FREE Full Text] - Articular cartilage: structure, injuries and review of management
- Abhijit M. Bhosale and James B. Richardson
BMB 2008 87: 77-95.[Abstract] [FREE Full Text] - Targeted therapies for pancreatic cancer
- S. A. Danovi, H. H. Wong, and N. R. Lemoine
BMB 2008 87: 97-130.[Abstract] [FREE Full Text] - Rating systems for evaluation of the elbow
- Umile Giuseppe Longo, Francesco Franceschi, Mattia Loppini, Nicola Maffulli, and Vincenzo Denaro
BMB 2008 87: 131-161.[Abstract] [FREE Full Text] - Visual function and fitness to drive
- Aachal Kotecha, Alexander Spratt, and Ananth Viswanathan
BMB 2008 87: 163-174.[Abstract] [FREE Full Text] - Current use of antiretroviral treatment
- A. C. Bailey and M. Fisher
BMB 2008 87: 175-192.[Abstract] [FREE Full Text]
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||