Professor Nicholas Talley named NSW Scientist of the Year

Laureate Professor Nicholas Talley, AC, Editor-in-Chief of the Medical Journal of Australia and MJA InSight, was named NSW Scientist of the Year at the NSW Premier’s Prizes for Science and Engineering on 30 October. Professor Talley, a neurogastroenterologist and Pro Vice-Chancellor (Global Research) at the University of Newcastle, specialises in unexplained gut disorders affecting nerves and muscles of the gut, such as irritable bowel syndrome (IBS), functional dyspepsia (indigestion), gastro-oesophageal reflux and gastroparesis (stomach pump failure). He was the first to identify a genetic contribution to IBS and functional dyspepsia, legitimising these disorders for millions of patients. His team described a new genetic form of IBS, identifying the first known mutation and showing that drug treatment could reverse the abnormal function. He is listed among the 400 most highly cited biomedical scientists in the world, and has published more than 1300 high quality articles in top ranking journals. In 2017, Professor Talley was named Australia’s most cited academic by Google Scholar and currently has more than 95 000 citations in the medical literature. He was also recognised this year with a Companion in the Order of Australia (AC) in the Australia Day honours. “As a medical researcher, searching for the truth and applying new knowledge to help patients has always been my goal. However, I feel my entire research team deserves the credit and this should not just be about me,” Professor Talley said.

Step forward for spinal cord recovery

Three patients with spinal cord injuries are able to walk again with targeted electrical stimulation of the spinal cord, according to Swiss research published in Nature. Epidural electrical stimulation (EES) — stimulation applied to the spinal cord — restores locomotion in animal models of spinal cord injury, but is less effective in humans for reasons that have remained unclear. The researchers administered targeted EES to three male patients with chronic spinal cord injury (sustained more than 4 years previously) and partial or complete lower limb paralysis. Motor neuron activation maps and simulated models were used to identify the optimum patterns of stimulation to different muscle groups. The EES was delivered by a pulse generator controlled in real time via wireless communication and was timed to coordinate with intended movement. Within a few days of starting treatment, patients progressed from stepping on a treadmill to supported walking on the ground (while receiving EES) and were able to adjust their step elevation and stride length. Eventually, patients could walk for up to one hour on the treadmill with EES. Following rehabilitation, the three patients could walk independently (either partially supported or with a walker) with EES and regained voluntary leg movements without EES. In an associated Nature Neuroscience article, the same authors showed that previous stimulation protocols to restore walking may have been less effective as they interfered with the patients’ perception of limb position. Stimulation in bursts promotes locomotion while preserving sensory signals coming from the legs.

Promising new approach to treat Parkinson’s

Researchers at the University of Queensland have found that a small molecule, MCC950, stopped the development of Parkinson’s in several animal models. Based on this discovery, they hope to develop improved drug candidates for human clinical trials in 2020. Parkinson’s is characterised by the loss of brain cells that produce dopamine, a chemical that coordinates motor control, and is accompanied by chronic inflammation in the brain. The researchers found that a key immune system target, called the NLRP3 inflammasome, “lights up” in patients with Parkinson’s, with signals found in the brain and even in the blood. MCC950, given orally once a day, blocked NLRP3 activation in the brain and prevented the loss of brain cells, resulting in markedly improved motor function in the animal models. There are no medications on the market that prevent brain cell loss in patients with Parkinson’s, with current therapies focusing on managing symptoms rather than halting the disease. “We have taken an alternative approach by focusing on immune cells in the brain called microglia that can clear these toxic proteins,” the researchers said. “With diseases of ageing such as Parkinson’s, our immune system can become over-activated, with microglia causing inflammation and damage to the brain. MCC950 effectively ‘cooled the brains on fire’, turning down microglial inflammatory activity, and allowing neurons to function normally.” The research is published in Science Translational Medicine.

Laparoscopic hysterectomies inferior to open surgery for cervical cancer

A 10-year study involving University of Queensland researchers suggests laparoscopic or robotic radical hysterectomy for cervical cancer is more likely to result in disease recurrence and reduced survival rates than open abdominal surgery. Queensland Centre for Gynaecological Cancer (QCGC) head of research, Professor Andreas Obermair, said the findings have already changed surgical care in gynaecological cancer centres across Australia and internationally. “Laparoscopic surgery remains a suitable choice for the 29 000 women who need a hysterectomy in Australia every year to treat abnormal [menstrual] bleeding, fibroids, pain and also uterine cancer. Laparoscopic surgery is preferred in these cases because it has shorter recovery times and fewer complications. But for women with cervical cancer, we found laparoscopic hysterectomies were associated with a three-fold increase in disease progression compared to open hysterectomies performed through an abdominal incision. The survival rate for these patients was also significantly worse compared to women who had open hysterectomies.” The trial involved 34 gynaecological cancer centres from 14 countries and was comanaged by the QCGC and the MD Anderson Cancer Center in Houston, Texas. The results are published in the New England Journal of Medicine.

What’s new online at the MJA

5 November Podcast with Dr Melissa Buttini, a consultant gynaecologist at the Wesley Hospital in Brisbane, and Associate Professor Christopher Maher, a urogynaecologist at the Wesley and Mater Hospitals in Brisbane, and at the Royal Brisbane Clinical Unit of the University of Queensland, talking about CO2 laser therapy for vulvovaginal atrophy … FREE ACCESS permanently

5 November Podcast with Professor Caroline Homer, AO, co-Program Director of Maternal and Child Health at the Burnet Institute in Melbourne, and Visiting Professor of Midwifery at the University of Technology Sydney, talking about new clinical practice guidelines for pregnancy care … FREE ACCESS permanently


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