Exercise as good as surgery for damaged middle-aged knees
Exercise therapy is as effective as surgery for middle-aged patients with a meniscal tear injury of the knee joint, according to a study published in The BMJ. Researchers from Denmark and Norway carried out a randomised controlled trial to compare exercise therapy alone with arthroscopic surgery alone in middle-aged patients with degenerative meniscal tears. They identified 140 adults (with an average age of 50 years) with degenerative medial meniscal tears, verified by a magnetic resonance imaging scan, at two public hospitals and two physiotherapy clinics in Norway. Almost all participants (96%) had no definitive x-ray evidence of osteoarthritis. Half of the patients received a supervised exercise program over 12 weeks (2–3 sessions each week), and half received arthroscopic surgery followed by simple daily exercises to perform at home. Thigh muscle strength was assessed at 3 months and patient-reported knee function was recorded at 2 years. No clinically relevant difference was found between the two groups for outcomes such as pain, function in sport and recreation, and knee related quality of life. At 3 months, muscle strength had improved in the exercise group. No serious adverse events occurred in either group during the 2-year follow-up. Thirteen participants (19%) in the exercise group crossed over to surgery during the follow-up period, with no additional benefit. “Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term,” the authors wrote. “Our results should encourage clinicians and middle-aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.”

New map of the human brain
Nearly 100 previously unreported regions of the human cerebral cortex have been identified in a new map of the brain reported online in Nature. The development of an accurate and high-resolution map of the microstructural architecture, connectivity and function of the human brain has long been an elusive objective of neuroscience, owing to technical challenges. Most existing maps are based on only one of these, or other related, neurological properties and on small numbers of individuals. These limitations result in “blurry” maps, which have not been reproducible across individuals. Researchers from Washington University in St Louis, United States, created a precise map of the brain using multiple types of imaging data of 210 healthy young adults from the Human Connectome Project. Their work divides each hemisphere of the brain into 180 specific cortical areas, 97 of which are newly described. The authors used a machine-learning technique to validate their map in an independent group of 210 additional participants and reported that their approach accurately identified these regions in new participants despite individual variability. The authors suggested that the new map could have clinical applications in neurosurgery and may also yield new insights into the cognitive evolution of humans by making comparisons with nonhuman primates. Video available here.

Engineered bacteria may fight cancer
United States scientists have used synthetic biology to create engineered bacteria that will self-destruct and release the drugs at the site of tumours. In a paper published online in Nature, researchers from the University of California San Diego described how they used a synthetic biology approach to engineer a genetic circuit — clusters of genes that impact each other’s expression — that controls the release of drugs in a tumour-targeting bacterium of the Salmonella strain. The authors first tracked bacterial population dynamics in colorectal tumours in mice. Subsequently, they orally administered the bacterium strain, alone or in combination with a clinical chemotherapeutic, to a mouse model of colorectal cancer. The authors found that the combination of both circuit-engineered bacteria and chemotherapy led to reduction in cancer activity and extended survival compared to either therapy on its own. The authors proposed that their approach may help to leverage the tools of synthetic biology in order to exploit the propensity of certain bacteria to colonise sites in the body affected by disease. Video available here.

AMSO presents gala concert in Melbourne
The Australian Medical Students’ Orchestra (AMSO) will present their inaugural concert, called “Genesis”, at the South Melbourne Town Hall on Sunday 31 July from 4 pm. Conductor Michael Dahlenburg will lead the AMSO in a program that includes Tchaikovsky’s Symphony no. 5, Rimsky-Korsakov’s Capriccio Espagnol and Fauré’s Masques et bergamasques. Tickets are $30 and $15, with proceeds going to Very Special Kids and the Afghanistan National Institute of Music. Tickets are available from www.amso.com.au.

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