|
Top 10 medical innovations for 2013
《时代》杂志评出2012年十大医学突破
Technologies to diagnose bacterial disease, scan for melanoma and tackle headaches are among the hottest tickets in healthcare innovation for 2013
Each year the renowned Cleveland Clinic in Ohio brings together physicians to gaze into their (admittedly well informed) crystal ball, and evaluate what are likely to be the hot tickets for healthcare innovation in the coming year.
Approaches that make the Cleveland Clinic’s Top 10 Medical Innovations for 2013 include technologies to tackle headaches, to diagnose bacterial disease, to scan non-invasively for melanoma and even to boost the number of lungs available for transplant.
Chris Coburn, executive director of Cleveland Clinic Innovations (CCI), offers us his insights about the predictions. CCI is the corporate venturing arm of Cleveland Clinic, and the clinic’s 55 spin-out companies have to date raised more than $650 million in equity investment.
美国《时代》杂志评选的各领域年度“十大”排名已于近日陆续出炉，医学领域“十大”突破也深入人心。涵盖了生命基础研究、艾滋病与癌症治疗突破、干细胞与再生医学、青少年健康等多方面公众关心的热点。
1.“垃圾DNA”才是掌控者
人体基因组中98%是没有编码的基因，以往它们被当作无用的“垃圾”。如今，人们发现这些被忽视的“垃圾”更有大用处。事实上，它们才是真正地基因掌控者和新陈代谢开关！它们调节着基因何时以何种方式发挥作用，怎样高效生产出不同的蛋白质。没有它们，基因就像是一堆连不成句子的杂乱单词。科学家正在探索这一新发现的生物信息宝库，以期找到能控制、甚至治愈某些疾病的基因开关。
2.人体微生物有""大作为""
人体中最多的成分是什么？细胞？基因？都不对，是微生物！它们的数量与人体细胞的比例达到10∶1。最近，研究人员刚刚完成了""人体微生组计划""的第一阶段，该计划旨在最广泛地了解人体内微生物的种类和作用。
大部分微生物是人类的朋友，比如帮人们消化食物，或增强免疫系统功能。但是随着研究深入，科学家发现体内微生物在许多慢性疾病和症状中，如炎症、肥胖等也起了关键作用。它们非但不是令人讨厌的闯入者，甚至还能帮我们攻克某些最难解决的健康难题。
3.抗HIV药“包揽全程”
“特鲁瓦达”（Truvada）已经成为抗艾滋病（HIV）的强大武器，它结合了两种抗病毒药物。而现在，它进一步成为第一款预防健康人群感染HIV的药物。经过基础性实验显示，未感染的人使用该药能降低其感染HIV的风险。美国食品与药品管理局（FDA）扩大了Truvada的许可范围，可能感染HIV的高风险人群也能使用该药。研究显示，高风险的男同性恋者及其HIV阳性伴侣，使用该药物后感染风险降低了42%到75%。
不过也有人担心，该药可能会导致无保护性行为等高风险行为增加，公共卫生专家则欢迎这种抗艾滋病的新方式——从第一步开始预防感染发生。
4.身体部分“实验室制造”
气管和肾脏或肝脏不同，并不属于常规的移植器官之列。但通过干细胞技术，也能给需要的病人培养出自己的气管。卡罗林斯卡研究院就用合成微纤维和从病人骨髓采集的干细胞，制作了一幅人造气管，并成功地连接了病人的鼻子、口腔和肺部，病人的气管因癌症而破坏。在首次病例中，一位死者捐献了气管，为一位西班牙妇女的干细胞提供了生长支架。而在最新进展中，科学家用生物医学基质来培养细胞。
这项技术代表了再生医学的未来，在此所有类型的干细胞，包括来自病人自己的皮肤细胞，都能作为生长任意类型细胞或组织的基础，供病人替换或修复。
5.逆转自闭症有了“新希望”
研究者称，早期行为疗法能帮助自闭症儿童的大脑模式恢复正常。患有自闭症谱系障碍的儿童，通过参与“早期起动丹佛模式”（Early Start Denver Model，ESDM）项目，其大脑在处理人脸及其他物体时有了改变。这对自闭症儿童的父母来说，无疑是个振奋人心的消息。
该模式包括大量与儿童有关的社交和语言活动。通常，自闭症儿童在观看无生命物体如玩具的图像时，其大脑比看到人物图像更活跃，但经过两年的ESDM治疗后，出现了相反的变化，并接近于正常发展的儿童。但经过良好培训的老师也是该项目成功的关键。
6.DNA分析“破冰”乳腺癌
乳腺癌无疑是一种复杂的疾病，由遗传、生活方式等多种因素导致。但研究人员通过对乳腺肿瘤的最新DNA分析，发现乳腺癌可能比原来所想的略微简单。
癌症基因组图谱项目对数十种癌症进行了基因组测序，在510个乳腺肿瘤样本中发现了3万个突变，但这些突变都可归入4个主要的亚型。其中一个亚型显示出与卵巢癌有着紧密联系，意味着治疗后者方法也可能有助于乳腺癌的治疗；另一种亚型解释了患有HER-2受体肿瘤的女性对某些药物，如赫赛汀（Herceptin）的个体疗效差异。这些成果将改变医生治疗乳腺癌的方式，有时候甚至是生存和不治之症的区别。
7.新生儿DNA诊断“提速”
50个小时，这就是目前破译和解读一个新生儿基因组所需要的时间，而过去要花几个星期甚至几个月。对重病婴儿来说，两天时间就是生死之别。这种快速基因组分析技术还结合了一种新软件，与3500种已知儿童疾病遗传缺陷相连，让医生能迅速决策用何种方法来拯救婴儿生命。
在每年进入新生儿加护病房的婴儿中，大约30%患有遗传疾病。今后，对他们进行基因组测序有可能成为提高护理水平的关键。
8.“解码”儿童肿瘤基因
近几年来，小儿癌症生存率已经提高到了80%到90%，不过这其中大部分要归功于肿瘤的早期诊断，以及一些成熟的治疗方法，包括外科手术、化疗和放疗等。
医生希望“小儿癌症基因组计划”能成为新的治疗标靶的“富源”。该项目为期3年，耗资6500万美元，旨在对主要的小儿癌症进行测序。理解了癌症的基因驱动机制，就有望揭示不同类型癌症之间的共同路径，使医生能在治疗各种肿瘤中互相借鉴，或开发出全新药物抑制生长异常的细胞。未来的癌症治疗，有望进一步提高生存率。
9.人造小鼠卵细胞
干细胞已经创造了许多看似不可能的生物医学奇迹：治疗糖尿病、帮助瘫痪病人重新行走、修复受损的心脏组织等。但即使对干细胞而言，要再生生命的最基本成分——卵子和精子，也是巨大的挑战。
日本科学家用了两种来自小鼠的干细胞，一种采自刚发育几天的胚胎，另一种来自重新编程的成年小鼠皮肤细胞，成功创造了有活力的卵细胞，然后使这些来自干细胞的卵细胞成功受精，并发育成了健康的幼鼠，而这些幼鼠的干细胞经测试也有再生能力。该成果代表了一项突破，有望为患不育症的人类夫妇提供新疗法。
10.病毒“消灭”青春痘
有时候，“以毒攻毒”是个好方法，如今医生也开始用这一方法来对付青春痘了。他们用一种比较“柔和”的病毒来对抗引发皮肤斑疹的细菌。事实上，这种病毒在皮肤的毛孔深处早已存在，它们具有感染细菌细胞的能力，现在要做的就是将其转变成“病毒制造厂”，提高病毒数量，然后就等着细菌自行毁灭。
研究人员称，你可以涂含有病毒的药膏，或更简单地涂含有病毒所产生的杀菌剂的药膏，两种方法都能为青少年带来清爽的皮肤。
CLAIRE O’CONNELL
Technologies to diagnose bacterial disease, scan for melanoma and tackle headaches are among the hottest tickets in healthcare innovation for 2013
Each year the renowned Cleveland Clinic in Ohio brings together physicians to gaze into their (admittedly well informed) crystal ball, and evaluate what are likely to be the hot tickets for healthcare innovation in the coming year.
Approaches that make the Cleveland Clinic’s Top 10 Medical Innovations for 2013 include technologies to tackle headaches, to diagnose bacterial disease, to scan non-invasively for melanoma and even to boost the number of lungs available for transplant.
Chris Coburn, executive director of Cleveland Clinic Innovations (CCI), offers us his insights about the predictions. CCI is the corporate venturing arm of Cleveland Clinic, and the clinic’s 55 spin-out companies have to date raised more than $650 million in equity investment.
10 Health insurance/Medicare Programme/Rewards for better health
Rising health costs are being driven in part by chronic diseases. The bipartisan Medicare Better Health Rewards Program Act of 2012 has been presented to US Congress as a way to improve healthcare and control costs for Medicare participants – the three-year programme aims to encourage people to take a more active role in their well-being by developing and maintaining healthy habits.
“This is a reflection of what is going on in terms of healthcare reform and the search for any possible approach to better incentivising patients to manage their own health affairs,” says Coburn.
9 Digital breast tomosynthesis
This form of “3D mammography” can be performed along with a conventional mammogram to provide a more accurate view of the breast.
During the mammogram the X-ray arm of the machine travels quickly in an arc over the breast, taking dozens of images at a number of angles that can then be combined to build up a three-dimensional image. The approach helps to visualise small cancers obscured by surrounding tissue. “It is nice to see a technology on this list that more directly addresses women’s health,” says Coburn.
8 Modular devices for treating complex aneurysms
An abdominal aortic aneurysm, or weakness in the wall of the aorta in the abdomen, can have catastrophic consequences if it ruptures.
Large or leaking aneurysms can sometimes be treated through a minimally invasive procedure using a stent graft, but many patients have anatomies that are not suitable for the grafts.
The concept here is a modular stent graft system that can be quickly customised to suit the patient.
“This modular design allows you to work around difficult anatomy, whether it’s bends or tortuous aspects, or that the aneurysm is adjacent to one of the exiting arteries from the aorta,” says Coburn. “It enables the customisation of a very important procedure to meet the needs of the patient.”
7 Ex-Vivo Lung Perfusion
This technology stands to increase the number of lungs available for transplant by “washing” the removed donor lung to address injury and improve the quality of the organ.
The donor lung is put in a bubble-like transparent chamber connected to a cardiopulmonary pump and a ventilator.
The organ is then exposed to special fluids, nutrients and oxygen, and in some cases targeted medications. And once it’s deemed viable, it’s ready to be transplanted.
“It offers the ability to increase the candidate pool,” says Coburn. “Fully deployed, it’s estimated there might be as much as a 40 per cent increase.”
6 Femtosecond laser cataract surgery
Cataracts are a leading cause of vision impairment, but surgery can remove the damaged tissue and implant a new intra-ocular lens.
Femtosecond lasers enable a “bladeless” cataract procedure that makes a circular hole in the lens capsule, splits the lens into sections and then softens and breaks up the cataract.
“It is very quick, very precise and – pardon the pun – a cutting-edge technology,” says Coburn.
“The concept here is the reliability and speed at which you can treat a large number of patients.”
5 Hand-held optical scan for melanoma
Melanoma is on the increase in many parts of the world, and early detection is important so the malignancy can be removed in good time.
This innovation is a hand-held device that a dermatologist can use in an office.
It shines lights of several wavelengths on the area to visualise the small blood vessels just below the surface of a mole or lesion, all without needing to cut the skin.
In this way the doctor can assess the patient without the need for biopsy and the potential scarring that could involve.
“The panel was impressed that this technology is so available and simple to use,” says Coburn, describing how one of the panel had been moved to use the term “game-changer”.
4 Drugs for advanced prostate cancer
The last couple of years have seen several drugs approved by the US FDA for advanced prostate cancer, and further developments are expected.
So perhaps this innovation’s spot on the list is akin to the “lifetime achievements” award – but there is more on the way.
“I think the panel felt here there had been such a consistent increase of new therapies for prostate cancer that they needed to recognise that,” says Coburn.
“It really was an acknowledgement of technologies that have broken through, and there had been enough action to acknowledge that treatment of prostate cancer has improved.”
3 Mass spectrometry for bacterial identification
If a patient has a serious bacterial infection, getting that diagnosis quickly and giving the appropriate medication can make all the difference.
Developments in mass spectrometry mean it’s now possible to identify bacteria from a patient sample in minutes rather than in days.
“It’s a combination of capabilities, of bringing existing mass spectrometry technology to bear,” says Coburn.
“There is a lot of enthusiasm in the pathology community and this will enable rapid turnaround and accelerate the treatment of patients.”
2 Neuromodulation device for cluster and migraine headaches
Migraine and cluster headaches cause enormous human misery and loss of productivity.
The innovation here is a miniature, implantable, on-demand stimulator for the sphenopalatine ganglion nerve bundle behind the face. Once it’s in place, the patient can control the device to help block pain.
“The procedure typically takes 45 minutes or less to implant it, going up above the gums to get to the roof of the mouth. There is no scarring,” says Coburn. “It’s really elegant technology and the early results are astounding.”
1 Bariatric surgery for control of diabetes
Type 2 diabetes is a serious health issue, and the risk of developing the chronic condition increases with obesity.
Recent studies have been finding that bariatric surgery – which alters the gastrointestinal tract to reduce energy uptake – can play a role in controlling Type 2 diabetes.
“Clearly bariatric surgery itself is not new, though there is some new technology,” says Coburn. “But the demonstration that this hideous disease, Type 2 diabetes, could be reversed was groundbreaking in the view of our panel.”
For more on the Cleveland Clinic’s Top 10 Medical Innovations for 2013, including short videos and a link to the associated app, see toptenmedicalinnovations.com
|
