Science, medicine, and the future: Bioinformatics

Molecular imaging in oncology

Cancer is a genetic disease that manifests in loss of normal cellular homeostatic mechanisms. The biology and therapeutic modulation of neoplasia occurs at the molecular level. An understanding of these molecular processes is therefore required to develop novel prognostic and early biomarkers of response. In addition to clinical applications, increased impetus for the development of such technologies has been catalysed by pharmaceutical companies investing in the development of molecular therapies. The discipline of molecular imaging therefore aims to image these important molecular processes in vivo. Molecular processes, however, operate at short length scales and concentrations typically beyond the resolution of clinical imaging. Solving these issues will be a challenge to imaging research. The successful implementations of molecular imaging in man will only be realised by the close co-operation amongst molecular biologists, chemists and the imaging scientists.

Drug reimbursement in Finland-a case of explicit prioritizing in special categories

Increased drug expenses have created challenges for drug reimbursement systems in many industrialised countries, including Finland. Prioritization of drugs could be one solution to this problem. This paper examines stakeholders' perspectives on the prioritization decisions made in the Finnish drug reimbursement system, particularly concerning drugs in the higher reimbursement categories. The analysis was based on 18 interviews with key stakeholders. The results revealed that authorities directly influencing the decisions tried to keep them as technical and non-political as possible. However, doing so was not easy, and there appeared to be hidden non-technical rationales behind many decisions. Stakeholders outside public administration had few opportunities to openly participate in decision-making because of the lack of transparency of the process. Despite this, they tried to influence decisions concerning their interests by using several means, such as lobbying the media, Parliament or other stakeholders. Transparent decision-making and better methods of open discussion on competing interests could promote democracy in the prioritization of drugs and perhaps reduce the harmful effects of indirect and unequal participation by different stakeholders.

Dissection of complex genetic disease: implications for orthopaedics

The sequencing of the human genome is a landmark achievement in the history of mankind and, in conjunction with new developments in genetic technology, is paving the way to a new era in biomedical research. The complete anatomy of the human genome is almost available. Detailed dissection to identify genes contributing to clinical disorders is underway and these will shape our understanding and treatment of common clinical conditions. This already is beginning to make an impact in medicine in terms of understanding disease etiology, clinical heterogeneity, and differential diagnosis. Furthermore it is advancing risk prediction for susceptibility, severity and outcome, the identification of new targets for drug discovery, and pharmacogenetic profiling of patients to predict their response to individual therapies. Major advances in genetics are occurring and it is important for clinicians in all areas of medicine to be aware of genomic approaches to understanding human disease. This is particularly important regarding orthopaedic conditions where the underlying genetic components are being established. This article does not presume a detailed knowledge in genetics by the reader and is intended to provide an introduction and concise overview of the potential future applications of genetics with reference to some orthopaedic conditions.

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Beyond the literature: bioinformatics training for medical librarians

As genetics and molecular biology progressively impact on society and the practice of medicine, medical librarians must prepare themselves to deal with this new arena of information. The Eskind Biomedical Library at Vanderbilt University Medical Center has developed a bioinformatics training program for its librarians involving subject knowledge, literature evaluation, and database searching techniques. This program can serve as a model for other libraries.

Bioinformatics in neurosurgery

WITH THE COMPLETION of the Human Genome Project, the amount of molecular biological sequence data available in public databases has reached staggering proportions. Data continue to accumulate at an exponential rate in the postgenomic era. Compilation, storage, searching, sharing, studying, and transmitting of all these data present formidable challenges. To keep pace with this extant database, the science of bioinformatics (sometimes called computational biology) has evolved. Bioinformatics is the combination of biology and computers and usually involves the storage or analysis of molecular biological sequence data at either the deoxyribonucleic acid, ribonucleic acid, or protein (amino acid) level. Most bioinformatics tools are freely available on the Internet for use by investigators around the globe. The collective wisdom from bioinformatics databases worldwide will continue to spawn advances in the neurological sciences for generations to come. Neurosurgeons must be aware of the power and potential applications of bioinformatics for the analysis of neurosurgical diseases.

Primer on medical genomics part II: Background principles and methods in molecular genetics

The nucleus of every human cell contains the full complement of the human genome, which consists of approximately 30,000 to 70,000 named and unnamed genes and many intergenic DNA sequences. The double-helical DNA molecule in a human cell, associated with special proteins, is highly compacted into 22 pairs of autosomal chromosomes and an additional pair of sex chromosomes. The entire cellular DNA consists of approximately 3 billion base pairs, of which only 1% is thought to encode a functional protein or a polypeptide. Genetic information is expressed and regulated through a complex system of DNA transcription, RNA processing, RNA translation, and posttranslational and cotranslational modification of proteins. Advances in molecular biology techniques have allowed accurate and rapid characterization of DNA sequences as well as identification and quantification of cellular RNA and protein. Global analytic methods and human genetic mapping are expected to accelerate the process of identification and localization of disease genes. In this second part of an educational series in medical genomics, selected principles and methods in molecular biology are recapped, with the intent to prepare the reader for forthcoming articles with a more direct focus on aspects of the subject matter.