Current surgical techniques for the repair of the musculoskeletal system can be often limited by the availability, quality and quantity of materials, such as grafts to effect repair. This has led to the exploration and development of novel methods of intervention based on tissue engineering and regenerative medicine.
This review summarizes the successes and investigations which are happening to date in the field of musculoskeletal tissue engineering. This is based on an extensive literature search and through basic research being performed by the authors.
Due to the constraints surrounding certain surgical techniques and restrictions on their use, novel procedures are required for the repair and regeneration of damaged tissues.
The choice of cell type has caused much debate within the tissue-engineering field. However it is widely accepted that currently only autologous primary/adult stem cells are fit for transplantation, until such times that optimized differentiation and selection protocols exist for embryonic stem cells.
The current results of the clinical cases utilizing tissue engineered constructs for bone and cartilage repair provide insights for improvement of these techniques thus allowing treatments to become increasingly viable.
There is a need to better understand the integration of scaffolds and cell populations into the target tissue. This should provide vital information influencing scaffold manufacturing procedures and cell selection.
A long-standing challenge in the treatment of depression is the development of a rapidly acting antidepressant. Conventional antidepressants typically require 2–8 weeks for clinical remission. In contrast, chronobiological interventions such as sleep deprivation treatment dramatically reduce depressive symptoms within 24–48 h in 40–60% of depressed subjects. It is hypothesized that fast-acting treatments for depression may alter circadian rhythms through chronobiological mechanisms relevant to clock gene function.
A bibliographic review using Entrez PubMed® with Boolean search terms ‘circadian’ and ‘depressive’ identified more than 1000 clinical papers published over a 40-year period (1966–present).
A large body of clinical data reports that sleep, temperature, hormone and mood changes in depression are consistent with disturbances in circadian-related processes.
Consensus has not been achieved in terms of defining underlying chronobiological mechanisms for optimal methods to produce rapid and sustained antidepressant responses to circadian interventions.
Chronobiological augmentation using combinations of sleep deprivation with light therapy and/or sleep phase advance in medicated patients supports a clinical strategy for accelerating and sustaining antidepressant responses.
Advances in technology including improved assays for clock gene expression will facilitate exploring the role of clock genes and may lead to new rapidly acting antidepressant strategies and potential novel drug targets.
Sports injuries in children affect both growing bone and soft tissues, and can result in damage of growth mechanisms with subsequent lifelong, growth disturbance. This clinical review unfolds the incidence and distribution, physiology, injury characteristics and the prevention modalities.
A comprehensive in Medline literature search was performed, and the reference lists of sports injuries related journals and text books was consulted.
During growth, there are significant changes in the biomechanical properties of bone. In young athletes, as bone stiffness increases and resistance to impact diminishes, sudden overload may cause bones to bow or buckle. Fractures that are initially united with some deformity can completely remodel, and the bone may appear totally normal in later life.
Most injuries caused in children's sports are minor and self-limiting, suggesting that children and youth sports are safe. The training programmes should take into account their physical and psychological immaturity, so that growing athletes can adjust to the changes in their bodies.
The global obesity epidemic has raised concerns about the risk of a tide of Type 2 diabetes (T2DM) in childhood. This paper aims to review the recent data on the epidemiology of this problem as well as the clinical concerns.
A literature search was performed on Medline, and articles about childhood T2DM, in English and published from 2000 to 2008, were reviewed.
A review of 16 paediatric studies suggest that although T2DM is now more widely reported in childhood, the numbers are still reasonably small although the data do suggest that ethnicity is an important risk factor.
Although there are emerging data on what appears to be a significant risk of both microvascular and macrovascular complications in youth onset T2DM, the most appropriate management remains unclear. Currently, adult guidelines for management of T2DM are being extrapolated to the adolescent population with T2DM.
Studies are currently underway to examine the pharmacological management of childhood T2DM.
More data are necessary on the exact prevalence of T2DM among a variety of populations to provide a greater understanding of the risk factors for T2DM and provide indications for screening. In the meantime, great emphasis needs to be placed on obesity prevention if we are to protect the health of future generations of children.
Turner syndrome (TS) is a genetic disorder associated with abnormalities of the X chromosome, occurring in about 50 per 100 000 liveborn girls. TS is usually associated with reduced adult height, gonadal dysgenesis and thus insufficient circulating levels of female sex steroids leading to premature ovarian failure and infertility. The average intellectual performance is within the normal range. New insight into genetics, epidemiology, cardiology, endocrinology and metabolism from a number of recent studies will be included in this review.
For this review we concentrated on all papers published on TS with special emphasis on the most recent literature. Also papers relating to cardiology, especially aortic dissection, paediatrics and the effects of estradiol in other conditions were considered. The main source was PubMed and the major endocrinology and cardiology journals.
Treatment with growth hormone (GH) during childhood and adolescence allows a considerable gain in adult height. SHOX deficiency explains some of the phenotypic characteristics in TS, principally short stature. Puberty has to be induced in most cases, and female sex hormone replacement therapy (HRT) is given during adult years. Morbidity and mortality is increased, especially due to the risk of dissection of the aorta and other cardiovascular (CV) diseases, as well as the risk of type 2 diabetes, osteoporosis and thyroid disease.
The proper dose of HRT with female sex steroids has not been established, and, likewise, benefits and/or drawbacks from HRT have not been thoroughly evaluated. In most countries it seems that the transition period from paediatric to adult care is especially vulnerable and the proper framework for transition has not been established. Today, most treatment recommendations are based on expert opinion and are unfortunately not evidence based, although more areas, such as GH treatment for increasing height, are well founded.
The description of adult life with TS has been broadened and medical, social and psychological aspects are being added at a compelling pace.
Proper care during adulthood should be studied, since most morbidity potentially is amenable to proper care. Especially, interventional strategy and follow-up with respect to congenital CV malformations, as well as secondary CV disease, have to be developed and new treatment algorithms have to be studied.
In summary, TS is a condition associated with a number of diseases and conditions, which need the attention of a multi-disciplinary team.
Since ancient times, competitive athletes have been familiar with the use of ergogenic aids and they will probably continue to use unfair and harmful substances in future, because their inclination to victory, along with the mirage of glory and money, will probably overcome health and legal risks.
We searched PubMed using the term doping over the period 1990 to the present day. We also included non-English journals.
By literature searching, it emerges that the phenomenon of doping is complex and multifaceted. It involves a number of causes and factors that do not originate solely in the athletic field, making universality its main feature. It is in fact observed in all ages and levels of competition, and it concerns all sports, even the most unpredictable.
The high number of athletes testing positive for anti-doping controls attests that the current strategy might be analytically adequate to unmask most (but not all) doping practices, but it is probably ineffective to prevent athletes to dope and modify this upsetting trend.
As doping parallels the use of medications, food supplements, alcohol and social drugs, a reinforced preventive policy is advisable.
The current anti-doping policy should be replaced with a more efficient and practical strategy to identify and monitor abnormal and harmful deviations of the biochemical and haematological profiles.
Parkinson's disease (PD) is one of the most common neurodegenerative disorders.
Literature search using Medline with keywords Parkinson's disease supplemented with previously published papers known to the author.
There have been significant recent advances in the understanding of the pathogenesis of the disease. There has also been a greater realization that the disorder may be associated with significant non-motor disturbances in addition to the more commonly recognized motor complications.
Although there is growing circumstantial evidence, it remains to be proven whether any of the current treatments for PD have a neuroprotective effect.
Although there is no cure, there are several management options for the early treatment of PD. As the disease progresses, further treatment options are available; however, the management of late-stage motor complications and non-motor symptoms remains particularly challenging and will benefit from further clinical research.
Osteoporosis has a huge impact on public health, through the increased morbidity, mortality and economic costs associated with resultant fractures. The goal is to evaluate and identify those that are at risk of osteoporotic fracture in order to start preventative and therapeutic measures to reduce their risk of fracture.
This article reviews the data from randomized controlled trials for the current therapeutic agents available in the UK. It also reviews new trial data for promising osteoporosis therapies, in particular Denosumab, a monoclonal antibody against RANK ligand.
Bisphosphonates are the current recommended first-line treatments for patients with osteoporosis.
There are a number of patients where bisphosphonates are contraindicated. Under these circumstances, it is important that clinicians have access to alternative treatments. The long-awaited National Institute for Health and Clinical Excellence (NICE) technology appraisals for both primary and secondary prevention and the clinical guidelines will clarify this. Treatment decisions should be based on risk factors and pharmaceutical intervention given to those with the highest risks.
Future studies are required to look at these agents in combination to see whether anti-fracture efficacy can be improved.