Stephen Kevin Smith

Academic medicine must take its global role: the M8 Alliance of Academic Health Centers and Medical Universities

At the inaugural World Health Summit in 2009, the M8 Alliance of Academic Health Centers and Medical Universities was formed to lead intensifi ed international debate about research and education in global health challenges. The idea was to create an international forum that seeks discussions with governmental representatives, policy makers, non-governmental organisations, civil society, and the health-related industry to initiate cross-sectoral solutions for the most pressing global health challenges. The fi rst Summit was a good start but wider engagement and a broader topic range are needed. So the second Summit, in Berlin on Oct 10–13, introduces three key themes: translation of research and education into health gains; transition of societies to having a majority of elderly people with chronic diseases, on the one hand, and increasing inequalities, on the other; and transformation of research and scientifi c innovation into policy changes. True medical advances only arise from collaboration and mutual understanding between academia and health-care and social systems. Policy makers should not be left to interpret research; academic leaders should be involved and translate the fi ndings. Isolated ivory towers will no longer do in the modern world. Governments, and ultimately taxpayers or donors, pay for research and expect a return in health gains. Global changes and new challenges demand inter-sectoral connectivity to achieve maximum health gains, especially in a climate of constrained fi nances. Neither governments nor market forces can prepare us for the medical challenges from global warming or the rising prevalence of mental ill-health or dementia within the next 10 years. We need global programmes and action plans based on science and led by academic institutions. Academic medicine must take more respon sibility for global health. Research agendas need timely adaptions to medical questions and health issues that will cut millions of lives short from largely preventable causes. The M8 Alliance regards its central mission to identify those challenges that will clearly benefi t from intensifi ed collaboration initiated by academia, which are largely independent from economic or political interests. Additionally, universities have the exclusive role to educate doctors and health-care workers, and prepare them for changing medical challenges. We need a strong globalisation process in medical education that diff erentiates and supports diverse medical career models. Dealing with multiple transitions, such as ageing populations, an epidemic of chronic diseases and comorbidities, and increasing inequality between and within countries, is complex. Societies worldwide are facing tough challenges in aff ordability of health care due to advances in technology, rapidly increasing health-care costs, and changes in demographics. Despite increasing medical knowledge applicable everywhere and sophisticated means to improve populations’ health in rich countries, there are huge defi cits in basic health care in low-income and middleincome countries. The diff erence in life expectancy between the richest and the poorest countries now exceeds more than 40 years. This enormous gap is dangerous and a precursor of global insecurity. In lowincome countries where a large part of health-care costs comes from out-of-pocket payments, the fi nancial crisis has increased the risk that people neglect health and prevention.

Menstrual effluent in endometriosis shows no difference in volume, VEGF-A, MMP2 and MMP9 or sFLT

Since retrograde menstruation is considered a key event in the aetiology of endometriosis, this study sought to determine whether the menstrual effluent of women with this condition is different from that of those with a normal pelvis. As the amount of blood lost during menstruation is thought to be higher in this group, measured objective menstrual blood loss (MBL) was measured. In addition, factors enhancing both ectopic implantation of endometrium and its subsequent growth (by establishing a neo-vasculature) were chosen for study. Our hypothesis was that they are increased in the menstrual effluent of women with endometriosis. The study showed that at the time of menstruation, there is no difference in MBL or in the volume of menstrual effluent between women with endometriosis and those with a normal pelvis at laparoscopy. In addition, vascular endothelial growth factor-A (VEGF-A) message and protein, soluble truncated receptor sVEGF-R1 (sFLT), matrix metalloproteinase (MMP) 2 and MMP9 activities were also shown to be similar between the two groups. It is concluded that the enhanced expression of VEGF-A and MMP in the peritoneal fluid and ectopic lesions of endometriotic patients may be a secondary event, resulting from an innate difference in peritoneal and systemic factors rather than in the endometrium, causing an abnormal peritoneal response to menstrual debris and facilitating its ectopic implantation.

Placental Vascular Morphogenesis: Introduction and Overview

While it is self-evident that the placenta is essential for the mammalian reproductive process, historically its role has been confused. The precise architectural arrangement of the blood vessels has been a matter of dispute, and this in part can be explained by the diversity of structures observed in common domestic, laboratory, and wild species (for a review of this subject area, see Kaufmann and Burton, 1994). However, by the beginning of the last century it had been established that the placenta served as an organ for fetal nutrition, respiration, and as an endocrine organ. All of the different placental types show specialized adaptations to facilitate exchange between the fetal and maternal circulatory systems. Both the human and murine placentae are of the hemochorial type, and although there are marked differences between them, knockout and transgenic studies in the mouse have been extremely informative. It is a reasonable assumption that the requirements for exchange play the most significant role in determining placental morphology, and therefore the adaptations of the fetal vasculature to facilitate this process are fundamental. In a range of species as gestation advances and fetal demand increases, the capacity of the placenta for exchange increases. In the human, there is a continual elaboration of the principal functional units of the placenta, the terminal villi, and a progressive reduction in the mean thickness of the villous membrane separating the two circulations. These changes, and the changes seen in other species, are dependent on continued angiogenesis, and therefore placental angiogenesis is central for the success of pregnancy.