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Making myasthenia less gravis
You have to be brave to organise a trial to confirm what we think we know, but have not yet proven. The trialists behind the single-blind, multi-centre, randomised trial comparing thymectomy and prednisolone to prednisone alone were braver still, seeing as it took them 6 years to accrue the 126 patients necessary to demonstrate the benefits of thymectomy. Those who had the operation had a lower ‘quantitative myasthenia gravis score’ (a new one on A Fo Ben, but lower is better), fewer needed immunosuppression or hospitalisation, and they were less distressed by their symptoms. These major landmark trials should be more routine and every patient should be expected to be entered in to a trial; not only for when we do not know the answer, but where we have not yet proven our biases to be true.
N Engl J Med 2016;375:511–22.
Phone a friend…
There may be no ‘I in team’—but there is a ‘me’. So how do the best doctors (by that I mean, you and I) fare when our diagnostic accuracy is compared to the aggregate diagnosis of many clinicians? Over 140 doctors who made 20 000 skin and breast cancer diagnoses were studied. Simply, the group outperformed the individual—but that does depend on the group. The greater the disparity between group members the poorer they fared. So there is wisdom in the crowd, but it must be a pretty bright and talented crowd.
Proc Natl Acad Sci USA 2016; 113: 8777–82.
Bird brained
‘Cognition without cortex’ sounds like a particularly pithy put down of a nemesis in middle management. However, it is also the title of a review article reminding us that the cortex is not essential for intelligence. Corvids and parrots, in keeping with all birds, have no cortex, and yet demonstrate primate levels of problem solving and learning. Bird cognition is defined by such qualities as gratification, mental time travel, reasoning, metacognition, mirror self-recognition, theory of mind, and third-party intervention. Again, these all seem like qualities lacking in people I reluctantly call colleagues. So is being called ‘bird brained’ all that much of an insult?
Trends Cogn Sci 2016;20:291–303.
Sow far, sow good
Scientists? What could be better than a transgenic pig? Yes, a transgenic mini-pig. And what could be better than a mini-me-pig? Yes, you're right, a glow-in-the-dark mini-piggy. The ubiquitin-proteasome system is thought to be important in Alzheimer's disease. In an attempt to look further at the proteasome, researchers tagged a proteasomal core subunit with green fluorescent protein that was incorporated into functional sperm proteasomes (figure 1). The brain activity (D iv) is particularly striking.
(A) Donor cell fibroblast expressing the protein. (B) Hatching day-6 blastocyst. (C) Transgenic-mini-pig. (D) Fluorescence in various pig tissues.
Proc Natl Acad Sci USA 2013; 110:6334–9.
A bum steer
With the calamity that is Brexit, this seems an opportune time to blame our current woes on ‘immigrants’. The Silk Road, the ancient network of trade routes connecting China to the Mediterranean, has been blamed for the spread of infectious diseases in times gone by. This theory, until now, had little evidence attached to it. The researchers who discovered an ancient latrine pit near Xuanquanzhi, a relay station on the Silk Road (111 BCE—CE109) must have thought that all their Christmases had come at once. What joy! What an opportunity to study the euphemistically called ‘personal hygiene sticks’ of ancient travellers. Imagine their unbounded bliss on discovering eggs from four species of parasitic intestinal worms: Chinese liver fluke, Taenia sp. tapeworm, roundworm and whipworm. This, they say, provides the earliest archaeological evidence for travellers from marshy areas of eastern or southern China and their worms along the Silk Road.
J Archaeolog Sci Rep Published Online First.
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