A Scandinavian editorial on the (mainly German) trials of cell therapy in myocardial infarction makes uncomfortable reading. The chosen end-points (ejection fraction etc) are of dubious clinical relevance and were inadequately measured, and the tiny benefit from therapy may be an artefact of using a toxic “placebo” – the culture medium for the cell preparations. Expect some heated correspondence.
Trials of different human papillomavirus vaccines have all of a sudden started arriving together like London buses. The exact route of this one is slightly different from the others, however, as it targets HPV 16 and 18 only. Others went for 6 and 11 as well. If you’re getting confused, there’s a good route map in the editorial on p.2135, plus handy tips on where to buy your tickets and put credit on your Oyster card. Anyway, they all end up at approximately the same destination, which is a reduction in cervical neoplasia of up to 90%.
A European survey measures the quality of life in children with cerebral palsy. It is largely unimpaired, except where the condition causes pain – very welcome news and a great credit to the change in attitude to “child cripples” (also called “spastics” until very recently) over the last decades, which reflects the extent of their integration into normal life.
A trial from Austria may have opened the floodgates to new treatments using autologous myoblasts and fibroblasts, by using them to close the female floodgates – the ones which fail in stress incontinence. The little ring of red muscle at the base of the bladder is called the rhabdosphincter, and we are all too familiar with the way it gets weakened by the stresses of childbearing, age and hormone deprivation. These investigators tried the effect of boosting the sphincter with ultrasound-guided injections of cells grown from biopsies of the patients’ own skeletal muscle. Unlike interventional cardiologists, the Innsbruck gynaecologists waited until they had a decent number of patients (63), used a harmless comparator (collagen injections) and measured a wide range of useful end-points. Very promising, perhaps even revolutionary (see editorial):90% of patients were continent at one year.
That great enemy of mankind, Neisseria meningitidis, may be sitting in your throat even as you read this. What turns it from a harmless commensal into a lethally rapid pathogen is not completely understood, but pretty well everything we do know about meningococcal disease is expertly summed up in this seminar, or can be found in its 184 references. It still sweeps across the “meningitis belt” of mid-Africa in periodic epidemics of fulminant disease, killing thousands. When we finally outwit this very resourceful little beast by producing an omnivalent vaccine, it may become a thing of the past, like smallpox, because it is only found in man.
Medical schools for the heath needs of the 21st century will, according to this paper from Bond University in Queensland, need to educate doctors above all to manage chronic diseases and to spot cancer early. Another name for this is general practice – not sexy, not very Lancet at all, but good sense from a medical faculty with a notable British GP, Chris Del Mar, at its helm.