Neural Tube Defects: From Origin to Treatment
http://www.100md.com
《新英格兰医药杂志》
Neural Tube Defects: From Origin to Treatment offers a comprehensive, timely, and sobering review of many aspects of neural tube defects and provides a wealth of information that is communicated (for the most part) in a clear and readable fashion. The sections on epidemiology, treatment and education, public health, and ethical issues are particularly informative.
The authors eloquently discuss the shortcomings of available treatment, especially for older survivors of the disease, with a focus on a lack of access to comprehensive care. The reader can almost feel the sheer frustration of the authors as they contrast unfavorably the service offered during childhood with the generally piecemeal service provided during adulthood.
The role of folic acid in neural tube defects is thoroughly explored, but the authors of the various sections admit (with some chagrin) that they still do not have a clear idea why folic acid has such a marked effect in the prevention of neural tube defects. Implementation of folic acid supplementation ought to have been easy, but it has not proved to be easy in practice. Bureaucracy must bear some responsibility, although I think some of the authors' criticism is a little harsh.
Although the book will have a wide international appeal, some sections are curiously American. Funding of services is always an issue, but the chapter describing the American experience has a particularly nightmarish quality to those of us accustomed to a more socialized system. The chapter on insurance and coverage should be obligatory reading for all American politicians with an interest in health care. The section concerning quality of life for survivors is somewhat at odds with many of the rather bleak outcomes reviewed in other sections. The reader needs to bear in mind that this work was done in the United Kingdom, where the medical system is much different from the systems in the United States and Canada.
The book has some deficiencies, most noticeably iconography. The illustrations in the sections on embryology are generally poor and do no service to the concise and clear text. In a similar way, descriptions of physical examination would be better supplemented with photographs and diagrams. There is inevitably some repetition, but this does not detract from the overall quality of the chapters.
Animal models are reviewed in some detail. Although they may help to unravel some of the intricacies of neural tube closure (given sufficient research funding), there has been no genetic contact between the animal model and humans since the common ancestor eons ago. If we still share the same basic system for neural tube closure, this part of the system must be robust and quite resistant to change. Weakness in the neural tube closure pathway may lie closer to humankind. As my daughter (a paleontologist) is fond of pointing out, although we humans regard ourselves as the pinnacle of evolutionary potential, common birth defects such as neural tube defects serve to remind us otherwise. With only 3 million years of human existence, we may yet prove to be evolutionary failures in the grand scheme.
John S. Bamforth, M.B., B.S.
University of Alberta
Edmonton, AB T6G 2H7, Canada
jbamfort@ualberta.ca(Edited by Diego F. Wyszyn)
The authors eloquently discuss the shortcomings of available treatment, especially for older survivors of the disease, with a focus on a lack of access to comprehensive care. The reader can almost feel the sheer frustration of the authors as they contrast unfavorably the service offered during childhood with the generally piecemeal service provided during adulthood.
The role of folic acid in neural tube defects is thoroughly explored, but the authors of the various sections admit (with some chagrin) that they still do not have a clear idea why folic acid has such a marked effect in the prevention of neural tube defects. Implementation of folic acid supplementation ought to have been easy, but it has not proved to be easy in practice. Bureaucracy must bear some responsibility, although I think some of the authors' criticism is a little harsh.
Although the book will have a wide international appeal, some sections are curiously American. Funding of services is always an issue, but the chapter describing the American experience has a particularly nightmarish quality to those of us accustomed to a more socialized system. The chapter on insurance and coverage should be obligatory reading for all American politicians with an interest in health care. The section concerning quality of life for survivors is somewhat at odds with many of the rather bleak outcomes reviewed in other sections. The reader needs to bear in mind that this work was done in the United Kingdom, where the medical system is much different from the systems in the United States and Canada.
The book has some deficiencies, most noticeably iconography. The illustrations in the sections on embryology are generally poor and do no service to the concise and clear text. In a similar way, descriptions of physical examination would be better supplemented with photographs and diagrams. There is inevitably some repetition, but this does not detract from the overall quality of the chapters.
Animal models are reviewed in some detail. Although they may help to unravel some of the intricacies of neural tube closure (given sufficient research funding), there has been no genetic contact between the animal model and humans since the common ancestor eons ago. If we still share the same basic system for neural tube closure, this part of the system must be robust and quite resistant to change. Weakness in the neural tube closure pathway may lie closer to humankind. As my daughter (a paleontologist) is fond of pointing out, although we humans regard ourselves as the pinnacle of evolutionary potential, common birth defects such as neural tube defects serve to remind us otherwise. With only 3 million years of human existence, we may yet prove to be evolutionary failures in the grand scheme.
John S. Bamforth, M.B., B.S.
University of Alberta
Edmonton, AB T6G 2H7, Canada
jbamfort@ualberta.ca(Edited by Diego F. Wyszyn)