Medicine-2013

Cloud Monitoring and Cancer Atlas
"Newspaper.Ru" recalls the brightest achievements of medicine in 2013Nadezhda Markina

Guided prosthesesDoctors and engineers are making progress in improving bionic prostheses that capture impulses passing through the nerves and become an extension of the human body.

Such bionic prosthetic legs, created at the Rehabilitation Institute of Chicago, are controlled by the nervous system and therefore guess the intention to turn right or climb a step. The principle of operation of such a prosthesis is to register with its sensors the electromyographic signals arising in the thigh muscles and "telling" the leg what to do next. In the future, they will be able to protect their owners from falls. And Vanderbilt University has created a bioprosthesis with controlled knee and ankle joints. It is a device with many sensors, including gyroscopes and acceleration meters, electric motors with rare-earth magnets and computer chips with low energy consumption.

And with the help of a device created at the Georgia Institute of Technology, a completely paralyzed person will now be able to control a wheelchair, for this he will only need a language. The system is a miniature magnetic tongue, which, being attached to the upper surface of the tongue, works as a joystick. A person moves his tongue right-left, forward-backward, transmitting commands to a head-mounted receiver, vaguely resembling headphones with microphones, and it, in turn, tells the computer what to do.

In the field of developing brain-computer interfaces that allow you to control external devices directly from the brain, an important step has also been taken — the monkey was taught to manipulate the "power of thought" with two virtual hands at once. In fact, she controlled her avatar. The experiment was conducted in the laboratory of the famous brain-computer interface specialist Miguel Nicolelis, at Duke University Medical Center. Neurophysiologists implanted a record number of electrodes into the brains of two monkeys and used a special algorithm to decode their activity. Until now, all such brain-controlled manipulators have moved only one hand. Switching to two hands is a fundamental step forward.

Cancer vaccinesCancer immunotherapy was named the main scientific breakthrough of the year by Science magazine.

This is a method that adjusts the human immune system to fight cancer. Its practical embodiment is anti—cancer therapeutic vaccines, which are administered not prophylactically to protect themselves from infection, but to an already ill person to help the immune system cope with the disease. Such vaccines are already undergoing clinical trials, such as the double-acting Pexa-Vec cancer vaccine, which simultaneously kills cancer cells and causes the formation of specific antibodies to cancer antigens.

This fourth-generation vaccine is based on a weakened and genetically modified cowpox virus. The virus can reproduce only in cancer cells, in addition, it carries a gene for a protein that stimulates an immune response. The effect of the vaccine was studied in three patients during clinical trials. One patient with renal cell carcinoma lived 76 months, another with small cell lung cancer - 24.5 months, the third with melanoma - 12 months. This is longer than they could have lived without vaccination, taking into account their condition, according to doctors.

Just a week ago, a message appeared about the encouraging results of a therapeutic vaccine against glioblastoma multiforme, one of the most aggressive brain cancers. It is almost impossible to remove it from the brain completely. Trials of the vaccine in the United States showed that six months after the start of treatment, 90% of patients were alive, a year later — 30%. These indicators are about one and a half times higher than with standard treatment. The mechanism of action of the vaccine is based on the activation of T-cell immunity. Specialists are moving along the path of personalized oncology, when treatment is based on the results of individual genomic analysis of a tumor in a particular patient.

This year, doctors from the Institute of Cancer Research at the University of Cambridge learned to monitor the genetic changes of a tumor based on the results of DNA analysis of cancer cells circulating in the blood. This allows, without subjecting the patient to the painful procedure of taking tissue for analysis, to monitor how the cancer evolves over time and how it responds to medications. In this way, doctors found specific mutations of drug resistance of the tumor.

A big step towards the personalization of treatment was the attempt to create a genomic atlas of cancer. 18 scientific articles (four of them published in Nature) present the first results of the Pan-Cancer Initiative project, which specialists from the National Cancer Institute and the National Human Genome Institute are working on. This is the result of an analysis of several thousand patients with twelve types of cancers. The global goal is to find biomarkers for fine classification of tumors and targets for the action of new drugs.

There is progress in the field of surgical treatment of cancer. A "smart" knife has been created that automatically detects the edges of a cancerous tumor, focusing on the readings of a built-in mass spectrometer that analyzes the composition of steam when heated. With its help, the surgeon can accurately cut out the entire tumor without leaving cancer cells and at the same time without affecting healthy tissue.

A ring or a transplant will save you from HIVIn the field of combating AIDS, progress has been made both in the treatment and prevention of the disease.

So, a case was registered when two patients completely got rid of HIV in the blood after a bone marrow transplant, which they were given according to indications – they were sick with leukemia. Getting rid of HIV is a side effect, but a very successful result of transplantation. The patients have been HIV-positive for about 30 years, against this background they developed Hodgkin's lymphoma, and after bone marrow transplantation for four, and the other for two years, no virus is detected in the blood. (Unfortunately, the success turned out to be temporary: see the note "The HIV treatment experiment ended unsuccessfully" – VM.)

And for a simple and effective HIV prevention , doctors suggested an intravaginal ring with an antiviral drug . The special polymer from which the ring is made allows you to create concentrations of the active substance a thousand times higher than those that could be achieved with other methods of drug delivery. The ring effectively protects women, who make up 60% of HIV-infected people.

Spare parts for humansResearch in the field of regenerative medicine, capable of restoring a damaged organ with the help of cells of the body itself, has stepped forward.

This year, several bioengineered organs were created using human cells. However, most of them have not yet earned in the human body, but in the body of laboratory mice or rats. To create these bioengineered organs, scientists take the skeleton of a mouse or rat organ, remove their own cells from it and plant human stem cells.

This is a bioengineered kidney from a rat kidney skeleton, which was populated with human renal epithelium cells; the test on the rat was successful: the kidney filters blood and produces urine. This is a liver from human stem cells, which grows in the mouse body and performs its functions. This is another liver grown from adipose tissue cells — liposuction waste. These are lungs derived from human skin fibroblasts, although not yet tested on animals. This is a bioengineered heart made of human cells on a mouse frame, which beats, although not yet in full force.

Also, human stem cells have served scientists to create blood vessels, working muscles. Finally, bioengineers grew a human ear, a life–size auricle, under the skin of a rat, and for the frame, which they seeded with human cells, they used cartilaginous tissue of a cow and sheep. Even the brain, or rather its prototype, was able to grow in the laboratory, in a Petri dish from stem cells. At the same time, the cells themselves organized into a kind of brain.

In the field of stem cell technology, it should be noted another achievement of our compatriot Shukhrat Mitalipov, who managed to obtain human embryonic stem cells in his American laboratory by transferring somatic cell nuclei into eggs. This is an invaluable resource for cellular medicine, which can now be designed by ourselves, and not extracted in other ways. Mitalipov's achievement was also noted by Science magazine among the scientific breakthroughs of the year. These technologies are still being worked out in the laboratory, but regenerative medicine has already stepped into the clinic, where it successfully saves lives.

Thus, the tracheal restoration operations carried out by Paolo Macchiarini are continuing, and this year the bioengineered trachea saved the life of a child for the first time. This trachea is made on a frame made of a special material, which, as the girl grows, will allow her to lengthen. And their own stem cells will help to avoid rejection. In our country, such operations are carried out in Krasnodar, where a Center for Regenerative Medicine has been established and work continues on the megagrant under the leadership of Macchiarini.

The most fantastic direction of regenerative medicine is printing using a 3D bioprinter. Although scientists are still very far from printing whole viable organs, but they are making steps in this direction. In particular, an important practical step was taken — the child was printed out a bronchus, more precisely, a piece of bronchus — a tube made according to individual measurements, which was used during the operation.

This year, the first laboratory for the development of methods of three-dimensional organ bioprinting appeared in Russia. The long—term goal of Vladimir Mironov, Sergey Novoselov and their colleagues is a human kidney, an intermediate functional model of a nephron — a renal element.

Another practical success of stem cell technology is that doctors from Germany brought a child out of a vegetative state with the help of cord blood cells. After transplantation of umbilical cord blood cells, the child's condition began to improve rapidly, he began to walk and talk. Scientists attribute the success to the ability of cells to migrate to the brain, where they replace damaged neurons.

Gene treatmentExperts pin great hopes on gene therapy, which allows to eliminate a defect in the work of some organ by introducing an artificial gene design.

In most cases, gene therapy is still being practiced on animals. So, this year scientists managed to cure a serious retinal disease — Leber's amaurosis — in rats and monkeys. An adenovirus was used to deliver a therapeutic gene construct. In another study, with the help of a gene, vision was returned to dogs.

In dogs , another disease , hemophilia B , was cured by gene therapy . In this case, with the help of a gene construct, a gene for the blood clotting factor was delivered to the body, the lack of which led to the disease.

Russian researchers from the Institute of Human Stem Cells have created a gene-activated transplant for bone restoration. In tests on rabbits, they showed that the introduction of a gene construct accelerates and improves the healing of bone defects.

In the same year, a new direction appeared, which can be called chromosomal therapy. Scientists have managed, however, so far "in vitro", to neutralize the activity of the extra 23rd chromosome, which leads to Down syndrome. It is hoped that someday doctors will be able to apply this knowledge to the treatment of children with Down syndrome.

Gadgets in the service of medicineSpecialists are attracting more and more electronic devices for healthcare needs.

Most often these are ordinary smartphones to which medical applications are created. So, a smartphone is already being used to diagnose cataracts, glaucoma and other visual diseases in residents of remote areas of Africa who do not have the opportunity to regularly visit an ophthalmologist.

Such a device was created by British specialists. The camera of a smartphone equipped with the necessary software and an additional set-top box can scan the lens of the eye to detect signs of cataracts, and with the help of a light flash, it can check the condition of the retina. The device's program, integrated with the Google Maps application, allows you to monitor patients and prescribe treatment by contacting a remote computer via the Internet.

And Russian specialists from Omsk have created a wireless heart monitor based on cloud technologies. The portable device constantly monitors the work of the heart and transmits information to the cardiologist's tablet or smartphone in case of any cardiac arrhythmias. Such monitoring will make it possible not to state a heart attack that has already occurred, but to see its approach with a high degree of probability. Cloud monitoring, unlike Holter monitoring, transmits the results of cardiac activity almost instantly, and in case of heart failures, it also instantly calls an ambulance.

IVF is becoming more accessibleThanks to the development of a cheap IVF method, women from poor developing countries will be able to take advantage of the achievements of reproductive technology.

The technology created by Belgian researchers reduces the cost of IVF to $ 257, and it is no less effective than the standard one, the cost of which (one fertilization cycle) is $12,400. Its creators abandoned the expensive incubator in which the embryo develops after fertilization. The system consists of only two glass tubes connected by needles and tubes. The first tube works as a CO2 generator, which is formed by a chemical reaction between citric acid and soda. It enters the second tube – with a culture medium.

Eggs and spermatozoa are injected into this tube. Fertilization takes place in it, and an embryo develops in it. Experts have tested the system for low-cost IVF and claim that it does not differ from the standard method in terms of the effectiveness of fertilization and embryo survival.

Portal "Eternal youth" http://vechnayamolodost.ru26.12.2013