New Frontiers In Medicine Research Articles

The endometrium as a source of mesenchymal stem cells for regenerative medicine.

Stem cell therapies have opened new frontiers in medicine with the possibility of regenerating lost or damaged cells. Embryonic stem cells, induced pluripotent stem cells, hematopoietic stem cells, and mesenchymal stem cells have been used to derive mature cell types for tissue regeneration and repair. However, the endometrium has emerged as an attractive, novel source of adult stem cells that are easily accessed and demonstrate remarkable differentiation capacity. In this review, we summarize our current understanding of endometrial stem cells and their therapeutic potential in regenerative medicine.

The Use of Non-Physicians in Cosmetic Dermatology: Legal and Regulatory Standards

The demand for cosmetic medical procedures continues to rise. Dermatologists are increasingly employing non-physicians, and medical spas are hiring individuals without a medical license to meet this demand. This new frontier in medicine has opened the door to a number of legal and regulatory issues regarding scope of practice and appropriate physician supervision of these procedures. Further confounding the matter is state-by-state variation in laws and a lack of federal oversight. We discuss some of the most salient factors clinicians need to be cognizant of in this rapidly evolving field of cosmetic dermatology. Physicians must be aware of the pertinent legal issues they face when using non-physicians in their practice or when acting as the medical director of cosmetic procedures taking place in a non-medical setting. As a medical community, we should be aware of the risks and benefits of non-physicians performing cosmetic procedures on patients.

Molecular markers to predict clinical outcome and radiation induced toxicity in lung cancer.

The elucidation of driver mutations involved in the molecular pathogenesis of cancer has led to a surge in the application of novel targeted therapeutics in lung cancer. Novel oncologic research continues to lead investigators towards targeting personalized tumor characteristics rather than applying targeted therapy to broad patient populations. Several driver genes, in particular epidermal growth factor receptor (EGFR) and ALK fusions, are the earliest to have made their way into clinical trials. The avant-garde role of genomic profiling has led to important clinical challenges when adapting current standard treatments to personalized oncologic care. This new frontier of medicine requires newer biomarkers for toxicity that will identify patients at risk, as well as, new molecular markers to predict and assess clinical outcomes. Thus far, several signature genes have been developed to predict outcome as well as genetic factors related to inflammation to predict toxicity.

In vitro testing of immunosupressive effects of mesenchymal stromal cells on lymphocytes stimulated with alloantigens

Mesenchymal stromal cells (MSC) derived from adult bone marrow or adipose tissue offer the potential to open a new frontier in medicine. MSC are involved in modulating immune response and tissue repair in vitro and in vivo. Experimental evidence and preliminary clinical studies have demonstrated that MSC exhibit an important immunomodulatory function in patients with graft versus host disease (GVHD) following allogeneic hematopoietic stem cell transplantation. The immunosuppressive properties of MSC have already been exploited in the clinical setting. However the precise mechanisms are being still investigated. We examined the immunosuppressive function of MSC by coculturing them with stimulated HLA incompatible allogeneic lymphocytes in a mixed lymphocyte culture test. The metabolic and proliferative activity of lymphocytes was determined by MTT test. After stimulation with alloantigens the presence of MSC caused significant decrease of absorbance levels by 62% (P<0.01), 26% (P<0.01) and 6% (P=0.0437) in comparison to positive control depending on the MSC/lymphocyte ratio (1:5, 1:50, 1:500). The mitogenic stimulation of lymphocytes with fMLP or PHA was also significantly reduced during MSC cocultivation. The absorbance was reduced by 42% (P<0.001) and 67% (P<0.001). Allogeneic bone marrow is an ideal source of MSC for clinical application. The experiments confirmed the dose-dependent inhibitory effect of MSC on lymphocyte proliferation triggered by cellular or mitogenic stimulation. The mixed lymphocyte culture test offers a simple method for characterization and verification of the immunosuppressive potential of MSC, being prepared for clinical use.

Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and the Federation of State Medical Boards

User-created content and communications on Web-based applications, such as networking sites, media sharing sites, or blog platforms, have dramatically increased in popularity over the past several years, but there has been little policy or guidance on the best practices to inform standards for the professional conduct of physicians in the digital environment. Areas of specific concern include the use of such media for nonclinical purposes, implications for confidentiality, the use of social media in patient education, and how all of this affects the public's trust in physicians as patient-physician interactions extend into the digital environment. Opportunities afforded by online applications represent a new frontier in medicine as physicians and patients become more connected. This position paper from the American College of Physicians and the Federation of State Medical Boards examines and provides recommendations about the influence of social media on the patient-physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician-physician communication that preserve confidentiality while best using these technologies.

Is Integrative Medicine the Next New Frontier in Medicine?

Complementary and alternative medicine (CAM) methods are increasingly being used by patients in the Western world to treat autoimmune or allergic diseases. Patients use these methodologies of their own accord, frequently against the advice of their physicians. Integrative medicine hopes to merge the benefits of both conventional Western medicine and CAM. More and more research is being conducted to decipher the secrets behind the thousands of years of experience that CAM offers. Are these treatments effective, and are they safe? Or do they act simply by the "placebo effect." This unique issue attempts to bring integrative medicine to greater awareness among Western physicians and practitioners.

Deep Brain Stimulation: Paradoxes and a Plea

Deep brain stimulation (DBS) represents a promising new frontier in medicine and neuroscience for managing disorders of mental health that represent an enormous burden of disease on our societies. The caution and significant restraint of leaders in the evolution of DBS today stand in sharp and refreshing contrast to previous episodes in history. In embracing the anticipatory and pragmatic problem-solving approach of neuroethics to clinical neuroscience, four significant paradoxes for DBS today come to the fore: caution and innovation, capacity and allocation of resources, notions of wellness and disease, and the high-stakes/high-benefit imperative of communicating about science. Tackling these paradoxes is the focus of this article.

SENTINEL workshop on ethical issues in radiology: a perspective from the European Parliament

In the European Parliament right now, the author is working with a small team of authors and shadow Members of the European Parliament (MEPs) on the proposed Advanced Therapy Directive(1). The directive deals with the regulation of cell, gene and tissue therapies. Though this is not the everyday work of radiology, it is an area in which radiology will play a part. It is the new frontier of medicine and for this reason it is the context in which the author, as a legislator with particular interest in people and health, works and in which it is arguably, easiest to see where ethics is going. In working out the details of the advanced therapy regulation, issues such as what is exempted, costs of registration, protection for small- and medium-sized enterprises (SMEs), etc., take up most of the directive. The decisions made here, for instance, about whether derogation should be granted for once-off hospital-based treatment rather than individual hospital-based treatment will have major financial implications down the line; yet this is not what is taxing the minds and hearts of the parliamentary team. It is the few words here and there that indicate ethical consideration; those that are making a usually cool socialist vice president of the parliament stamp her foot, slam down her pencil and threaten to walk out if the words are included in the directive.

Genomic medicine: a new frontier of medicine in the twenty first century

Although the concept of heredity has been in existence since ancient times, the science of genetics began to evolve only around 150 years ago. The Darwinian theory of evolution by natural selection made clear reference to hereditary factors that reflect at least some of the present-day concepts of the genetic basis of life. Mendel’s laws of inheritance, and successive discoveries in various aspects of genetics, laid the foundation for a number of disciplines covering different areas within the modern science of genetics. The emergence of human genetics was no exception. It has taken six decades since the recognition of DNA as the carrier of hereditary information to arrive at our present state in the science of genetics. The future now appears bright, opening up many new and challenging opportunities. During the last four decades, medical genetics has established itself covering clinical and laboratory diagnostic applications. The basis of medical genetics is grounded in a sound knowledge and understanding of principles governing ‘human genetics’. Clinical genetics is now a recognized medical specialty among several disciplines comprising the current spectrum of modern medicine. Fifty years after the discovery of the double-helical structure of the deoxyribonucleic acid [DNA] molecule (Watson and Crick 1953), the characterization of the virtually complete sequence and organization of the human genome was successfully accomplished (Lander et al. 2001; Venter et al. 2001). This major scientific achievement laid the foundation of ‘human genomics’; that section of the biological sciences which studies variations, mutations and functions of genes and controlling regions, and their implications for human variation, health and disease. This is strengthened by developments in the other areas of genomics relating to micro-organisms, animals and plants. The identification of all human genes and their regulatory regions provides the essential framework for understanding the molecular basis of disease. This advance has also provided a firm foundation for the future development of genomic technologies that can be applied to medical science. Rapid developments in global gene analysis, gene product analysis, medical bioinformatics, and targeted molecular genetic testing are destined to change the practice of medicine. However, many practicing clinicians perceive developments in genomics as primarily confined to the research arena with little clinical applicability. DNA/ RNA-based methods of disease susceptibility screening, molecular-based disease diagnosis and prognosis, and genomics-based therapeutic choices and prediction of treatment outcome are some of the key areas that are likely to influence the practice of modern clinical medicine. Undoubtedly, the science of genomics has tremendous potential for improving human health. The World Health Organization [WHO] has recently made several recommendations for the scope and application of genomics on global health (WHO 2002). It is acknowledged that the information generated by genomics will provide major benefits in the prevention, diagnosis and management of communicable and genetic diseases as well as other common medical diseases, including cardiovascular diseases, cancer, diabetes and mental illnesses (Cardon and Bell 2001). Together these constitute a major health burden, as reflected in chronic ill-health and mortality. In addition, a number of infectious diseases are associated with genomic mutations manifesting in the form of increased susceptibility, clinical severity, favorable and unfavorable response D. Kumar (&) Institute of Medical Genetics, University Hospital of Wales, Cardiff University, Heath Park, CF14 4XN Cardiff, UK e-mail: kumard1@cardiff.ac.uk

Metabolic Disorders in the Center of Genetic Medicine

Genetics is the new frontier of medicine. Hardly an issue of any leading medical journal is published without one or more articles on a genetic disease or a topic closely related to genetics. A recent series of articles in the Journal was devoted to the importance of genetics in medical practice.1 The immediate impetus for such a series was, as is widely known, the sequencing of the human genome and the promise that that effort would lead to better diagnosis and treatment of disease.2 However, the knowledge that many metabolic disorders are genetic has long been seen as evidence, with . . .

Mesenchymal stem cells avoid allogeneic rejection

Adult bone marrow derived mesenchymal stem cells offer the potential to open a new frontier in medicine. Regenerative medicine aims to replace effete cells in a broad range of conditions associated with damaged cartilage, bone, muscle, tendon and ligament. However the normal process of immune rejection of mismatched allogeneic tissue would appear to prevent the realisation of such ambitions. In fact mesenchymal stem cells avoid allogeneic rejection in humans and in animal models. These finding are supported by in vitro co-culture studies. Three broad mechanisms contribute to this effect. Firstly, mesenchymal stem cells are hypoimmunogenic, often lacking MHC-II and costimulatory molecule expression. Secondly, these stem cells prevent T cell responses indirectly through modulation of dendritic cells and directly by disrupting NK as well as CD8+ and CD4+ T cell function. Thirdly, mesenchymal stem cells induce a suppressive local microenvironment through the production of prostaglandins and interleukin-10 as well as by the expression of indoleamine 2,3,-dioxygenase, which depletes the local milieu of tryptophan. Comparison is made to maternal tolerance of the fetal allograft, and contrasted with the immune evasion mechanisms of tumor cells. Mesenchymal stem cells are a highly regulated self-renewing population of cells with potent mechanisms to avoid allogeneic rejection.

Animal models for intestinal tissue engineering

Although total parenteral nutrition prevents patients with short bowel syndrome from dying of starvation, having short bowel remains a severely debilitating condition. The best current treatment for inadequate absorptive surface area is through intestinal transplantation. However, this therapy is associated with significant morbidity and patients suffer from consequences of long-term immunosuppression. Additionally, the numbers of organs are limited. A new frontier in medicine is the field of tissue engineering. We will review the progress of intestinal bioengineering with a focus on the use of animal models. Investigators initially used autologous tissue as a patch to study intestinal regeneration. Subsequent studies focused on the use of absorbable biomaterials as a patch for tissue ingrowth. The most novel methodology consists of seeding a resorbable scaffold and implanting this construct to observe the regeneration of neointestine. Successful creation of esophagus, stomach, small bowel and colon has been demonstrated. Although these studies are preliminary, the results suggest that tissue-engineered intestine will become a real therapeutic option in the not too distant future for patients with inadequate intestinal tissue.

The Doctor-Patient Relationship

Back to table of contents Previous article Next article LetterFull AccessThe Doctor-Patient RelationshipJanet S. Richmond, M.S.W.Janet S. RichmondSearch for more papers by this author, M.S.W.Published Online:1 Sep 1999https://doi.org/10.1176/ps.50.9.1233-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In his article on the depersonalization of health care in the March 1999 issue, Dr. Zealberg (1) takes us on a nostalgic journey back to the roots of the healing professions, namely, the sanctity of the relationship between the doctor-therapist and patient. He uses Buber's I-Thou, I-It paradigm to illustrate how dehumanization in health care erodes this relationship and can interfere with caring for the patient.Those of us who have worked with combat veterans know that dehumanization is an essential ego defense that makes war possible. When the enemy is perceived as a nonhuman, it becomes easier to kill. In the extreme, this type of objectification leads to the commission of atrocities (2,3). The recent events in Yugoslavia remind us just how quickly such a defense can erupt; the Holocaust of World War II serves as yet another reminder.When I was in training over 20 years ago, I learned about the healing power of the doctor-patient relationship. My mentors spoke of the healing professions as a "calling" rather than a career choice. I was taught that people pursue this calling in response to a "reparative need" (4,5) and that caregivers who are successful temper their own needs in deference to the patient's needs. Patient and therapist create a therapeutic alliance—a sacred bond in which transference (and countertransference) reactions, once fully understood, promote healing.The 1980s were exciting times for psychiatry. An explosion of scientific discoveries in molecular biology, neuroscience, and psychopharmacology led to the development of a panoply of more effective psychotropic agents. These discoveries pushed psychiatry into new frontiers in medicine, promoting the Talmudic mandate of "tikkun olam," literally translated from the Hebrew as "mending or repairing the world." Yet, without the I-Thou relationship, no healing could take place, for a "dose of the doctor goes with every prescription" (4,5). When we sit and help our patients bear their suffering, we enter an intimate and sacred space—a spark of the divine rests between therapist and patient.On the dawn of a new millenium, we seldom hear the term "calling" in reference to our professions. Dr. Zealberg reminds us that despite managed care, the business of medicine remains that of healing and caring for the sick. If we are to survive as caring practitioners, we must attend to the sacred within each of us and within each of our patients. Once the I-It relationship becomes the model, we cannot guarantee that we will "do no harm."Ms. Richmond is director of the emergency psychiatry service at the Veterans Affairs Medical Center in Boston and assistant clinical professor of psychiatry at Boston University School of Medicine.

Using decision analysis to aid in the introduction of upper extremity transplantation

Transplanting a head and brain is perhaps the final frontier of organ transplantation. The goal of body-to-head transplantation (BHT) is to sustain the life of individuals who suffer from terminal disease, but whose head and brain are healthy. Ideally BHT could provide a lifesaving treatment for several conditions where none currently exists.BHT is no ordinary experiment, to transfer a head to another body involves extraordinarily complex medical challenges as well as ethical and existential dilemmas that were previously confined to the imagination of writers of fiction. The possibility of replacing an incurably ill body with a healthy one tests not only our surgical limits, but also the social and psychological boundaries of physical life and alters what we recognize life to be.The purpose of this target article, the complementary manuscript focused on immunological issues in BHT, and the accompanying Commentaries by scholars and practitioners in medicine, immunology, and bioethics is to review major surgical and psychosocial-ethical and immunological considerations surrounding body-to-head transplantation. We hope that together these ideas will provide readers with a comprehensive overview of the possibilities and challenges associated with BHT and initiate professional discussion and debate through which this new frontier in medicine is considered and approached.

S-H5-01 Infrared spectroscopy: A new frontier in medicine: Henry H. Mantsch Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, Manitoba

S-H5-01 Infrared spectroscopy: A new frontier in medicine: Henry H. Mantsch Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, Manitoba