These important subjects are approached in the Bulletin this quarter and have full free online access. In addition, the Bulletin is beginning a new section which will celebrate its amazing archive (see end of this section). Meanwhile, our first review is Sudden cardiac death (pages 5–15) by Kandala, Oommen and Kern from the University of Arizona, Tucson, USA. They state that sudden cardiac arrest continues to be the leading cause of death in the industrialized world. Community programs for lay bystander CPR and automatic external defibrillation improve outcomes. Increasingly data show that chest compression-only CPR is preferred by lay rescuers and improves local survival rates. Randomized clinical trials are underway to examine the utility of early coronary angiography in the treatment of post-arrest patients without ST segment elevation.
The second free-to-view review is entitled Ethical issues of Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR) technology and gene editing through the lens of solidarity (pages 17–29) is by Mulvihill, Capps, Joly, Lysaght, Zwart and Chadwick from the University of Oklahoma Health Sciences Center, USA, Dalhousie University and McGill University, Canada, National University of Singapore, Radboud University, The Netherlands and the University of Manchester, UK. They say that CRISPR technology, a bacterial immune system modified to recognize any short DNA sequence, cut it out, and insert a new one, has rekindled hopes for gene therapy and other applications and raised criticisms of engineering genes in future generations. CRISPR—Cas9 has taken the pace and prospects for genetic discovery and applications to a high level. The biggest new issues are the void of research on human germ cell biology, the appropriate routes for oversight and transparency, and the scientific and ethical areas of reproductive medicine.
In the rest of the Bulletin, the third review is entitled Surgical versus conservative management of type III acromioclavicular dislocation (pages 31–49) by Longo, Ciuffreda, Rizzello, Mannering, Maffulli and Denaro from the University of Rome, Italy, University of Melbourne, Australia, University of Salerno, Italy, Barts and The London School of Medicine, UK. They state that the management of type III acromioclavicular dislocations is still controversial. They compared the rate of recurrence and outcome scores of operative versus nonoperative treatment of patients with type III acromioclavicular dislocations. Persistence of pain seems to occur less frequently in patients treated surgically for a type III acromioclavicular dislocation. There is insufficient evidence to establish the effects of surgical versus conservative treatment on functional outcome of patients with acromioclavicular dislocation.
The fourth review is entitled Colour vision requirements in visually-demanding occupations (pages 51–77) by Barbur and Rodriguez-Carmona from the City University, London, UK. They say that normal trichromatic colour vision (CV) is often required as a condition for employment in visually-demanding occupations. If accurate CV tests were available to enforce this requirement, a significant percentage of subjects with anomalous, congenital trichromacy who can perform the suprathreshold, colour-related tasks encountered in many occupations with the same accuracy as normal trichromats would fail. These applicants would therefore be discriminated against unfairly. One solution to this problem is to produce minimum, justifiable CV requirements that are specific to each occupation. A single colour assessment test is needed to establish the applicant's CV category.
The fifth review is entitled Effect of vitamin D deficiency in developed countries (pages 79–89) by Hassan-Smith, Hewison and Gittoes from Queen Elizabeth Hospital and University of Birmingham, UK. They state vitamin D deficiency is common worldwide with adverse effects on skeletal health. In recent years, there has been great interest in non-classical actions of vitamin D. Current evidence supports the use of vitamin D supplementation in deficiency to improve skeletal outcomes such as falls/fracture risk and bone mineral density. There is debate reflected in guidelines on optimal thresholds for circulating levels of vitamin D. A number of studies have investigated the extra-skeletal effects of vitamin D deficiency but causality in humans has yet to be confirmed.
The sixth review is entitled The effectiveness of prolotherapy in treating knee osteoarthritis in adults (pages 91–108) by Hassan, Trebinjac, Murrell, and Maffulli from the Heart of England NHS Foundation Trust, Birmingham, UK, Dubai Physiotherapy & Rehabilitation Center and Barts and the London School of Medicine, UK. They say that osteoarthritis (OA) often leads to symptoms such as pain, stiffness, and decreased function. Prolotherapy has been used to treat various musculoskeletal problems and has shown some promise. Meta-analysis was not possible due to heterogeneity of outcome measures and populations. Moderate evidence suggests that prolotherapy is safe and can help achieve significant symptomatic control in individuals with OA.
The seventh review is entitled Screening for secondary findings in clinical genomics research (pages 109–122) by Mackley and Capps from University of Oxford, UK and Dalhousie University, Canada. They say that due to decreasing cost, and increasing speed and precision, genomic sequencing in research is resulting in the generation of vast amounts of genetic data. There has been much discussion around the issue of ‘secondary findings’—findings unrelated to the research that have diagnostic significance. Research participant autonomy and their informed consent are paramount—policies around secondary findings must be made clear and participants must have the choice as to which results they wish to receive, if any.
The eighth review is entitled Apoptosis and rotator cuff tears (pages 123–133) by Osti, Buda, Del Buono, Osti, Massari and Maffulli from Modena, the University of Ferrara, and Fidenza Hospital, University of Salerno, Italy and Barts and The London School of Medicine, l London, UK. They say that excessive apoptosis has been hypothesized as a possible cause of tendinopathy and tear in the tendons of the rotator cuff (RC). The homeostasis between the apoptotic and inflammatory processes is dynamic and controlled by pro- and anti-apoptotic mechanisms and signals, with variable balance in different areas of the rotator cuff tendons in human specimens. Further studies are needed to produce clear guidelines to determine how to balance the apoptosis process to reduce the failed healing response found in non-traumatic RC tears.
The ninth review is entitled Return to sport following stress fractures of the great toe sesamoids (SFGTSs) (pages 135–149) by Robertson, Foffin, and Wood from Royal Infirmary of Edinburgh, UK. They provide information on return rates and times to sport following SFGTSs. The management principles were to attempt conservative management for 2–6 months using activity modification, analgesia, orthotics and physiotherapy; if symptoms persisted following this, surgical management was to be recommended, either with internal fixation or sesamoidectomy. The optimal treatment modalities for SFGTSs remain to be defined. Internal fixation shows the best return to full-level sport rates with low rates of complications. Future prospective studies should aim to establish the optimal treatment modalities for SFGTSs.
The tenth review is entitled Physiotherapy management of lower limb osteoarthritis (pages 151–161) by Walsh, Pearson and Healey from University of the West of England and Keele University, UK. Osteoarthritis (OA) of the lower limb affects millions of people worldwide, and results in pain and reduced function. There is strongest evidence to support the use of exercise to improve pain, function and quality of life. There is limited evidence to support the use of some commonly utilized physiotherapy interventions. Programmes that include single exercise type may be more beneficial than combined strengthening and aerobic interventions. Studies that investigate packages of care, combining interventions require further investigation.
The eleventh review is entitled Targeted therapy and maintenance in myeloma (Pages 163–177) by Mateos and González-Calle from University Hospital of Salamanca, Spain. They state that maintenance therapy aims to extend progression-free survival (PFS) and overall survival (OS), but the convenience of administration, tolerability and toxicity of treatment are essential to bear in mind. It is necessary to define the role of risk factors and minimal residual disease monitoring for tailored maintenance. The development of new therapies and monitoring strategies able to individualize the maintenance to prevent both under and overtreatment are needed.
From the archive
The British Medical Bulletin (BMB) has an extensive archive dating back to 1943. The journal is publishing, for the first time this quarter, selected papers from that archive. The first of these, which can be freely accessed online is a fascinating piece written by Alexander Fleming on The Discovery of Penicillin. You can also access these articles by visiting the ‘Highlights from the BMB Archive’ collection: (http://bit.ly/2nTsFIH).
April 2017
