Introduction to nanotechnology: potential applications in physical medicine and rehabilitation

Nanotechnology is a scientific movement that has the potential to transform the diagnosis and treatment of disease in the 21st century. The area of investigation is defined by the study, design, manipulation, manufacture, and control of materials or devices by physical or chemical means at resolutions on the order of one billionth of a meter. The potential for a wide range of clinical applications makes a basic understanding of nanotechnology important to physiatrists. This review presents an introduction to nanotechnology and discusses key developments in tissue engineering, drug delivery, imaging, diagnostics, surface texturing, and biointerfaces that could impact the practice of physiatry in the future.     

Fibronectin: applications to clinical medicine

In summary, the role of fibronectin in clinical medicine is not yet certain. Correlation of sepsis and organ failure with decreased fibronectin levels is still to some degree questionable; controlled clinical trials are urgently needed. The risk of hepatitis, AIDS, and other transfusion-transmitted diseases must be balanced by data substantiating the clinical efficacy of fibronectin therapy. To date, no results from controlled trials using purified fibronectin have been reported. Final judgement must be reserved pending results of appropriate human studies. It is likely, however, that even if fibronectin is proven to be clinically useful, the patient population which will achieve some benefit from its use will be restricted to septic and/or critically ill patients. As noted by Mosher and Grossman however, physicians treating such patients would likely welcome any new and effective therapeutic intervention.     

Benchmarking: applications to transfusion medicine

Benchmarking is as a structured continuous collaborative process in which comparisons for selected indicators are used to identify factors that, when implemented, will improve transfusion practices. This study aimed to identify transfusion medicine studies reporting on benchmarking, summarize the benchmarking approaches used, and identify important considerations to move the concept of benchmarking forward in the field of transfusion medicine. A systematic review of published literature was performed to identify transfusion medicine-related studies that compared at least 2 separate institutions or regions with the intention of benchmarking focusing on 4 areas: blood utilization, safety, operational aspects, and blood donation. Forty-five studies were included: blood utilization (n = 35), safety (n = 5), operational aspects of transfusion medicine (n = 5), and blood donation (n = 0). Based on predefined criteria, 7 publications were classified as benchmarking, 2 as trending, and 36 as single-event studies. Three models of benchmarking are described: (1) a regional benchmarking program that collects and links relevant data from existing electronic sources, (2) a sentinel site model where data from a limited number of sites are collected, and (3) an institutional-initiated model where a site identifies indicators of interest and approaches other institutions. Benchmarking approaches are needed in the field of transfusion medicine. Major challenges include defining best practices and developing cost-effective methods of data collection. For those interested in initiating a benchmarking program, the sentinel site model may be most effective and sustainable as a starting point, although the regional model would be the ideal goal.     

Nanoparticles in medicine: therapeutic applications and developments

Nanotechnology is the understanding and control of matter generally in the 1-100 nm dimension range. The application of nanotechnology to medicine, known as nanomedicine, concerns the use of precisely engineered materials at this length scale to develop novel therapeutic and diagnostic modalities. Nanomaterials have unique physicochemical properties, such as ultra small size, large surface area to mass ratio, and high reactivity, which are different from bulk materials of the same composition. These properties can be used to overcome some of the limitations found in traditional therapeutic and diagnostic agents.     

Functional assessment in rehabilitation medicine: clinical applications

Functional assessments have become a cornerstone of rehabilitation medicine, assisting in well-defined aspects such as: quality assurance, continuous quality improvement, accountability, cost/benefit analysis, education, and research. In the second part of the 20th century, scaling techniques have become an integral part of the rehabilitation medicine discipline, and everybody is aware of their essential importance. However, even when engaged in a purely scientific discussion on the theoretical, mathematical basis of these measurements, a fundamental question arises as to what depth of accuracy is it possible to bring such measurements into a clinical scenario (or any real scenario). When it comes to the integration of all these principles, a balance must be achieved between pure theory and clinical applications, making it accessible for the average clinician and department routinely running functional evaluations. All these considerations are discussed with examples of data management that can be performed by systematically collecting data with the help of a computerized database where demographic, clinical and functional data is recorded. Rehabilitation teams and systems must be aware of function measurement principles and applications and determine their position in this regard.     

Proteomics: applications relevant to transfusion medicine

With the completion of the human genome sequence, it is now possible to analyze the many individual components that comprise complex biologic systems. Despite this sequence data, understanding the biologic relationships of all proteins of a given cell or biologic sample (the proteome) is still an exceedingly difficult task. However, new technology developments mean that proteomics research can be used to investigate a variety of biologic systems. Already, these studies have given valuable insight for the development of improved diagnostic and therapeutic products. The present review aims to provide a basic understanding of proteomics research by discussing the methods used to study large numbers of proteins and by reviewing the application of proteomics methods to transfusion medicine.     

MicroRNA及其在医学中的应用

MicroRNAs（miRNAs）是近年来发现的一种非编码的sisRNA,长度仅22个核苷酸左右,普遍介导基因转录后的调节,参与调控机体各种生理进程。miRNA与疾病如肿瘤的发生发展密切相关。研究发现血液循环中也存在miRNA,循环miRNA或可作为肿瘤无创诊断的新靶标。本文就miRNA的来源、功能、与疾病的关系、检测方法及其在肿瘤诊断和治疗中的应用等方面的研究进展作一综述。     

Ivabradine: potential clinical applications in critically ill patients

It has been extensively demonstrated that an elevated heart rate is a modifiable, independent risk factor for cardiovascular events. A high heart rate increases myocardial oxygen consumption and reduces diastolic perfusion time. It can also increase ventricular diastolic pressures and induce ventricular arrhythmias. Critical care patients are prone to develop a stress induced cardiac impairment and consequently an increase in sympathetic tone. This in turn increases heart rate. In this setting, however, heart rate lowering might be difficult because the effects of inotropic drugs could be hindered by heart rate reducing drugs like beta-blockers. Ivabradine is a new selective antagonist of funny channels. It lowers heart rate, reducing the diastolic depolarization slope. Moreover, ivabradine is not active on sympathetic pathways, thus avoiding any interference with inotropic amines. We reviewed the literature available regarding heart rate control in critical care patients, focusing our interest on the use of ivabradine to assess the potential benefits of the drug in this particular setting.     

Alphavirus vectors: development and potential therapeutic applications

Alphaviruses are RNA enveloped viruses that are proving their value as expression vectors. They are particularly well-suited for this role as they are easily and quickly engineered and can be used to produce high levels of proteins of interest. A promising and important use is as vaccines against disease-causing agents such as HIV. The three alphaviruses now serving as vectors are Sindbis virus, Semliki Forest virus (SFV) and Venezuelan equine encephalitis (VEE) virus. Sindbis virus and SFV are well-known models for studies in molecular and cell biology; VEE virus is a human pathogen and had received some previous notoriety as a potential biological weapon. It is now becoming a potentially valuable vaccine vector. All three viruses are being tested as vaccines but, at present, only Sindbis virus and SFV have been considered for other uses. Sindbis virus vectors have been developed to screen libraries for the identification of new proteins and to devise sensitive assays to detect viruses more difficult to grow in culture. Both Sindbis virus and SFV vectors are serving as tools for fundamental studies in biology, examples include development in insects and analysis of protein functions in neuronal cells. In this article the replication strategy of alphaviruses and the different ways they can be engineered to serve as expression vectors is described. This provides an introduction to the ways these vectors have been used and illustrates the promise these vectors offer.     

Pegvisomant: current and potential novel therapeutic applications

Background: Pegvisomant is a genetically engineered molecule, which exhibits specific growth hormone (GH) antagonism by directly interacting with the GH receptor. It is currently licensed for the treatment of acromegaly where surgery and medical therapy with somatostatin analogues have failed. Objective: To delineate the role of pegvisomant in the treatment of acromegaly and its novel application in other areas of clinical medicine where suppression of GH action may be of therapeutic benefit. Methods: A literature review from PubMed- and EMBASE-listed publications and the web-sites of licensing organisations for medicinal products. Conclusion: Pegvisomant is currently used as a second line therapy in the management of acromegaly. It is highly effective in suppressing the metabolic effects of elevated GH levels when used alone or in combination with somatostatin analogues. However, its long term efficacy and safety for this indication has yet to be established. Preliminary data indicate that pegvisomant may have a role in management of type 1 diabetes with beneficial effects on insulin sensitivity and in preventing the progression of microvascular complications. Additional roles as an adjunct to cancer chemotherapy regimens and for the diagnosis of GH deficiency have been proposed, but have yet to be confirmed.     

Flavonoids from duckweeds: potential applications in the human diet

Duckweeds are the smallest free-floating flowering aquatic plants. Their biotechnological applications include their use as food, bioenergy, and environmental sustainability, as they can help clean polluted water. The high growth capacity and their chemical properties make them suitable for human health applications. Here we evaluated the ethanolic extracts from five species of duckweeds by HPLC-DAD/MS-MS for chemical characterization. Sixteen compounds were identified and quantified, in which three were chlorogenic acid derivatives and eleven apigenin and luteolin derivatives. We describe for the first time the presence in duckweeds of 5-O-(E)-caffeoylquinic acid (1), 3-O-(E)-coumaroylquinic acid (2), luteolin-7-O-glucoside-C-glucoside (3), 4-O-(E)-coumaroylquinic acid (4), luteolin-6-C-glucoside-8-C-rhamnoside (5), and luteolin-8-C-glucoside-6-C-rhamnoside (6). The flavonoids diversity showed a significant content of luteolin and its derivatives, except for Landoltia punctata that had significant apigenin content. Flavones identified in duckweeds were mostly C-glycosides, which can benefit human diets, and its abundance seems to be related to the higher antioxidant and anticancer capacities of Wolffiella caudata, Wolffia borealis, and Landoltia punctata. Our findings reinforce the idea that duckweeds could be valuable additives to the human diet, and their potential should be further explored.

Duckweeds are the smallest free-floating flowering aquatic plants.     

Potential applications of gene therapy in sports medicine

Gene therapy has the potential to improve greatly the management of sports medicine injuries. By the expeditious introduction of the appropriate genes to sites of injury, it should prove possible to initiate healing responses in those tissues that normally fail to heal, to accelerate healing in tissues which do naturally heal, and to improve the quality of the repair tissue. In addition, genes with anti-inflammatory properties offer novel possibilities for the control of chronic, sports related inflammation. None of these applications of gene therapy in sports medicine is yet in the clinic. It would seem, however, only a matter of time before the first clinical trials emerge. Their acceptance will be facilitated by the two human protocols that are presently underway for the treatment of rheumatoid arthritis. The present status of sports medicine gene therapy is summarized in Table 3.