Faculty of 1000

Faculty of 1000 Medicine, a major new online service designed to help medics keep abreast of the most important new research, was launched in January. Run by a team of almost 2,500 of the world’s leading researchers and clinicians, Faculty of 1000 Medicine provides a consensus view of important articles and trends across medicine. The continuously updated service, found at www.f1000medicine.com, will be available to institutional and personal subscribers.

A new feature exclusive to Faculty of 1000 Medicine is the Clinical Impact label highlighting research findings that Faculty Members think will have an immediate effect on clinical practice.

Faculty of 1000 Medicine is headed by an International Advisory Board of world leaders in medicine including Steven Hyman, Provost of Harvard University, and Sir Keith Peters, Emeritus Regius Professor of Physic at Cambridge University. Divided into 18 Faculties, the service covers the whole of medicine – from Anaesthesiology & Pain Management to Women’s Health. The Faculty is further divided into approximately 200 sections representing worldwide monitor Update from around the globe specific research areas, which are cross-indexed to reflect the interdisciplinary nature of medicine.

Women’s heart disease

In as many as 3 million US women with coronary heart disease, cholesterol plaque may not build up into major blockages, but instead spreads evenly throughout the artery wall. As a result, diagnostic coronary angiography reveals that these women have “clear” arteries – no blockages – incorrectly indicating low risk. Despite this, many of these women have a high risk for heart attack, according to newly published research from the US National Institutes of Health.

In women with this condition, called coronary microvascular syndrome, plaque accumulates in very small arteries of the heart, causing narrowing, reduced oxygen flow to the heart, and pain that can be similar to that of people with blocked arteries, but the plaque does not show up when physicians use standard tests. As a result, many women go undiagnosed, according to findings from the National Heart, Lung, and Blood Institute's (NHLBI) Women's Ischemia Syndrome Evaluation (WISE) study. Insights from the study are published in a special supplement to the 6 February issue of the Journal of the American College of Cardiology, available online.

“When a diagnosis of this condition is missed, women are not treated for their angina and high cholesterol and they remain at high risk for having a heart attack,” said NHLBI director Elizabeth G Nabel, MD. “This study and the high prevalence of coronary microvascular dysfunction demonstrate that we must think out of the box when it comes to the evaluation and diagnosis of heart disease in women.”

Artificial bone

Researchers supported by the US National Institute of Dental and Craniofacial Research (NIDCR) report they have harnessed the unique physics of sea water as it freezes to guide the production of what could be a new generation of more biocompatible materials for artificial bone.

In the article “Freezing as a Path to Build Complex Composites” published in the January 27 issue of the journal Science, the researchers used this novel technique to produce a thinly layered composite, or hybrid, structure that more closely mimics the natural scaffolding of bone. The scientists said their initial, proof-of-principle scaffolds are desirably ultra lightweight and up to four times stronger than current porous ceramic implant materials.

According to Dr Antoni Tomsia, a scientist at Lawrence Berkeley National Laboratory in Berkeley, California and senior author on the paper, the still nameless freezing technique, with further technical refinements, could churn out even stronger materials and could be scaled up to fabricate larger structures, such as replacement hips and knees and a variety of dental materials.

Endometriosis & IVF

Findings published in The Cochrane Library (www.cochrane.org) in January state that the live birth rate per woman was significantly higher in women with endometriosis who received gonadotrophin releasing hormone (GnRH) agonist for three to six months before commencing in vitro fertilisation (IVF), compared to control groups.

By conducting a systematic review of literature, review authors found that giving GnRH agonists to women with endometriosis for three to six months prior to fertility treatment produces more than a fourfold increase in the chance of becoming pregnant.

“The chances of having a live birth are also increased, though currently the data is not strong enough to show how great that increase is,” says lead author Professor Hassan Sallam, who works in Obstetrics and Gynaecology in Alexandria University, Egypt.

Ongoing pain

New research shows that it is undamaged nerve fibres that cause ongoing spontaneous pain, not those that are injured.

These unexpected findings, by Dr Laiche Djouhri, Professor Sally Lawson and colleagues from the University of Bristol, UK, are reported in the Journal of Neuroscience in January.

Previous research into ongoing chronic pain has tended to focus on the damaged nerve fibres after injury or disease and overlooked the intact fibres. This new understanding may help pharmaceutical companies formulate novel pain killers.

Professor Lawson said: “The cause of this ongoing pain and why it arises spontaneously was not understood before. Now that we know the type of nerve fibres involved, and especially that it is the undamaged fibres that cause this pain, we can examine them to find out what causes them to continually send impulses to the brain. This should help in the search for new analgesics that are effective for controlling ongoing pain.”

Ongoing pain is a burning or sharp stabbing/shooting pain that can occur spontaneously after nerve injury. Unlike ‘evoked’ pain caused, for example, by hitting your thumb with a hammer, ongoing pain is particularly difficult to live with because it is often impossible to treat with currently available pain killers.

Djouhri and Lawson show that the nerve cells responsible are ‘nociceptors’ or damage detectors. There are thousands of these nerves cells, each of which has a very long, fine nerve fibre emerging from it. These fibres run within nerves and connect the skin or other tissues to the spinal cord.

When activated through damage or disease, these nerve fibres fire electrical impulses that travel along the fibre from the site of injury to the spinal cord, from where information is sent to the brain. The faster the undamaged fine fibres fire, the stronger the ongoing pain becomes.

Dr Djouhri added: “The cause of this firing appears to be inflammation within the nerves or tissues, caused by dying or degeneration of the injured nerve fibres within the same nerve.”

The mechanism described by Djouhri and Lawson occurs following nerve injury and in nerve and tissue inflammation. Further research is now needed to establish how generally this mechanism may contribute to ongoing pain associated with a wide variety of diseases such as back pain or shingles.

MI & stem cells

In January doctors at the Catholic University of Leuven, connected with the University Hospital – Gasthuisberg, the Stem Cell Institute Leuven (SCIL), and the Flanders Interuniversity Institute for Biotechnology (VIB), published a major breakthrough in the treatment of patients with acute myocardial infarction. Their research shows that the administration of a patient’s own stem cells has a significant positive effect on the heart’s recovery: in the patients studied, the size of the infarct was clearly reduced. The use of stem cells appears to be safe, and to date no side effects have occurred that can be attributed to the stem cells. The study was due to be published in The Lancet.

The researchers in Leuven have tested the administration of bone marrow stem cells on patients stricken with acute myocardial infarction. In the 67 patients of the study, the supply of blood in the heart was restored optimally via the balloon technique. Then, within 24 hours, some patients received an injection of stem cells from their own bone marrow and some received an aqueous (placebo) solution (the patients in each group were selected by drawing lots). Such a doubleblind, placebo-controlled study has never before been conducted.

Collaboration among the cardiology, hematology, radiology and nuclear medicine services yielded an unparalleled study in which state-of-the-art technology was used to investigate changes in the left ventricle, blood supply and heart metabolism.

Improvement in the global functioning of the left ventricle was comparable in both the control group (injected with the placebo) and the group that received the stem cells. But a clear global improvement in function was found in the subgroup of patients who had been afflicted with the most serious infarctions. Moreover, the reduction of the size of infarct was significantly greater in all patients in the 'stem cell group' and correlates with a better preserved regional left ventricle function. It is still much too early to conclude that every patient with a myocardial infarction should be treated with stem cells and there is still a long road to travel in the development of a medication.

COX-2 & breast cancer

Regular use of selective COX-2 inhibitors significantly reduces the risk of breast cancer. A case-control study (Reduction in the Risk of Human Breast Cancer by Selective Cyclooxygenase-2 (COX-2) Inhibitors) published late January in the open access journal BMC Cancer observed that daily use of selective COX-2 inhibitors, including celecoxib (Celebrex) and rofecoxib (Vioxx), was associated with a 71% reduction in the risk of breast cancer. Non-selective COX-2 inhibitors, such as aspirin and ibuprofen, also reduced the risk of breast cancer. This study highlights the potential of nonsteroidal antiinflammatory drugs (NSAIDs) for the prevention of breast cancer.

Nursing training

The nursing profession should be deeply concerned that the reality gap between education and practice identified three decades ago still remains today, according to a commentary in the latest Journal of Advanced Nursing.

Professor Jill Macleod Clark from Southampton University says that despite considerable efforts by the profession to bring about change, the basic problems identified in a 1976 paper by Eve Bendall continue to cause concern.

Dr Bendall’s paper, which is reprinted in the 30th Anniversary Issue of the Journal, had warned that there was a danger of producing nurses who were “increasingly proficient on paper and decreasingly proficient in practice”.

She believed that what nurses were learning in theory was becoming increasingly divorced from what they were actually doing in practice.

In an up-to-date commentary, Professor Macleod Clark, who is head of the University’s School of Nursing and Midwifery, says that a total review of the nursing education system is called for and tough policy measures need to be introduced.

“We also need sufficient funding to resource and radically modernise the practice learning requirements and outcomes of nursing students in the 21st century” adds the professor, who is also Chair of the Council of Deans and Heads of UK Faculties for Nursing and Health Professions.

Professor Clark added that the profession has made considerable efforts to bring about change, but that the pressures on today’s nurses are a key factor in the continuing “reality gap” identified by Eve Bendall.

Cartilage innovation

Leeds bioengineers have developed an innovative technique for cartilage repair combining the self-healing powers of the body with stem cell science to help young people avoid debilitating knee problems and give hope to arthritis sufferers.

Current treatments of cartilage defects in the knee are expensive, have lengthy recovery times, and can even cause as much damage as good.

The bioengineers have invented a repair technique – and tools – that cut surgery times from two hours to ten minutes, and can have patients back on their feet within three weeks. The treatment involves a surgical technique called subchondral drilling, where holes are drilled into the bone beneath the cartilage in the damaged site, causing bleeding from the bone marrow, which stimulates stem cells to grow tissue within the damaged area. Surgeons then implant a felt-like pad, to encourage the cells to expand and grow into tissue.

As the treatment uses the body’s own stem cells, it is much cheaper than existing methods, where tissue is engineered outside the body and then implanted. The system has potential for widescale applications. Researchers say initially young people with small defects will be most suitable for treatment, but once the system has been put through its paces it might well be used for larger defects in older arthritic patients.

Lung disease detector

A new technique based on the same technology used to detect chemical warfare agents and explosives is being employed by scientists at The University of Manchester to treat hospital patients with lung disease. Researchers are using a sensor, commonly used to detect explosives at airports, to develop a new way of diagnosing lung disease.

The microDMx sensor, developed by Sionex Corporation, is being used to develop a new technique which is able to detect ‘unhealthy’ molecules present in the breath of a patient.

The technology is currently being tested at Wythenshawe Hospital’s North West Lung Research Centre. The aim is to produce a device which will enable doctors to monitor patients with lung or respiratory conditions by simply asking them to breathe into it.

Dr Paul Thomas from the University’s School of Chemical Engineering and Analytical Science, who is leading the research, said: “What is unique about this sensor, and the use of the microDMx technology, is the fact that it can be configured to not just analyse one disease or condition, but it has the potential to be used to analyse a broad spectrum of conditions from asthma, to cancer and metabolic disorders such as diabetes.”

MRSA spreads in amoeba

The MRSA ‘superbug’ evades many of the measures introduced to combat its spread by infecting a common single-celled organism found almost everywhere in hospital wards, according to new research published in the journal Environmental Microbiology.

Scientists from the University of Bath have shown that MRSA infects and replicates in a species of amoeba, called Acanthamoeba polyphaga, which is ubiquitous in the environment and can be found on inanimate objects such as vases, sinks and walls.

As amoeba produce cysts to help them spread, this could mean that MRSA may be able to be ‘blown in the wind’ between different locations.

Further evidence from research on other pathogens suggests that by infecting amoeba first, MRSA may emerge more virulent and more resistant to antibiotics when it infects humans.

“Infection control policies for hospitals should recognise the role played by amoeba in the survival of MRSA, and evaluate control procedures accordingly,” said Professor Mike Brown from the Department of Pharmacy and Pharmacology at the University of Bath.

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