The Health and disease of humans are an area of concern and interest among the medical fraternity ever since the system of modern medicine evolved. Continuous and varied research studies are taking place in many regions to find solutions to the myriad health problems that are seen to be increasing over the years. Any serious studies on health and disease are most welcome in such situations since even a little information can contribute to the control and cure of the many still fatal diseases prevalent (and even growing) in society today.
It is appreciable that a study on the occurrence of Uterine Leiomyomas has been done by Markus Klemke et al to find a link between the mutation of the so-called high mobility group of proteins classified as HMGA type and the occurrence or development of subsets of Uterine Leiomyomas. This paper critically reviews the study and the paper to arrive at a conclusion on its effectiveness and the ultimate benefit, if any, that this study has been of use to the medical community at large.
There is a mention in the paper that let-7, one of the two identified micro-RNA (the other being lin-4) has a regulatory effect on the HMGA2 proteins. Other studies also have corroborated this observation. “Several studies proposed let-7 as a putative tumor suppressor, especially in lung cancer”. (Sun lee & Dutta 2009)
Review and critique of the study
The researcher state that “Uterine leiomyomas (UL, fibroids) are the most frequent gynecological tumors and, despite being benign, constitute an enormous public health burden.” Even though this type of tumor is considered to be benign and hence not fatal, they cause other health problems and concerns. The researchers Klemke, Markus et al. (2008). Overexpression of HMGA2 in Uterine Leiomyomas Points to its General Role for the Pathogenesis of the Disease. (Provided by the Student).
have listed some of the problems caused by the growth, but could have listed more to stress that this area needs more such studies for finding an answer to its occurrence. Menorrhagia, abdominal pain, and infertility are the most common problems associated with uterine leiomyomas, according to the researchers. But pelvic pressure, urinary incontinence, ureteral obstruction, bleeding that occurs outside of the menstrual cycle (periods) are also seen.
It is essential that all the implications of a particular health condition be revealed. Physicians and others associated with research may be aware of all these, but stressing will always help in people being more aware of the need for further research. The study has rightly claimed at the start itself that this condition is extremely common in women. This has been corroborated in other reports and studies. “Uterine leiomyomas, or fibroids, are the most common tumours of women in the United States, probably occurring in the majority of women by the time they reach menopause and becoming clinically significant in about one-third of these women.”
Another small shortcoming is that the reader has to assume that the study was done in the United States since reference to this is seen only when they say that incidence in higher in African American females when compared to whites from both America and Europe. An international reader will be at a loss as to which country the results pertain to. This is relevant because incidence levels are difference among ethnic groups.
They also have not mentioned about the nationalities of the patients from whom the tissue samples were taken. Assuming the study was conducted in the United Sates, the samples could have come from a varied ethnic source considering that the country is home to a lot of variety in ethnicity. Other studies have also confirmed this aberration or variation in occurrence with regard to ethnicity. “Positive adjusted associations were observed between risk of uterine leiomyoma and self-described African-American ethnicity.”
In the absence of lack of classification, there is a possibility that the results may not give a concise result. In such a case the researchers should have taken the samples from one single prominent ethnic group in the country. On the other hand, if the sample is really from one single group, the fact should have been mentioned in the paper. This again is a small drawback of this study.
The researchers can be appreciated for using a number of methods for analysis of the tissue samples. The methodology includes RNA isolation (reverse transcription and quantitative RT-PCR), gene expression analysis, cell culturing, chromosome analysis, and florescence in situ hybridization or FISH. The efficacy of these methods for this type of research is reviewed below.
RNA Isolation, Reverse Transcription, and Quantitative RT-PCR
Other studies have also used “reverse transcriptase-polymerase chain reaction (RT-PCR) experiments.” The give example pertains to a study by a Japanese research team studying practically the same area as seen in this research also. Hence this particular methodology can be said to be relevant here. So, the researchers have used the correct methodology in this instance.
Gene expression analysis
The researcher had done an analysis of gene expression using RNA an a control factor. Here also studies with regard to uterine leiomyoma have used analysis of gene expression in their studies. And example would be a study conducted on uterine leiomyoma by a team of researchers in China even though the focus area of the study was quite different. Here also RNA was used “up-regulation and down- regulation of gene expression.” Hence analyzing gene expression for studies of this nature is practiced by other researchers as well.
Chromosome analysis
It appears that chromosome analysis is commonly used in tumour research for a long period time. A review of literature shows that this type of analysis is a part of tumour research even way back in 1973. This can be seen from a journal article published in 1977 in the Cancer Research journal. “Chromosome studies on freshly removed tumour tissue were performed at intervals over a 2-year period from September 1973 to June 1975”. So the fact that this method has been used in this instance does not warrant any criticism. Moreover the researchers have also used other methods mentioned above in the study.
Cell culture
Culturing of cells as a part of tumour research has been practically used for many years. Cell culture has been a part of this study also. “Tumour cell aggregates have been used as cell culture models of cancer cells for many years.” It appears that the way in which those cultures were developed, as described by the researchers is done correctly.
Fluorescence in situ hybridization (FISH): This again is a commonly used method of analysis in such types of research where cell aberrations occur. “FISH is applied in many areas of basic research as well as in clinical cytogenetics.” FISH has been used in this study also which is quite acceptable for study of tumours.
It can be seen that the methods used in this research has been acceptable since many other studies with regard to tumour research in general and studies of uterine leiomyoma in particular are using similar methods. There can be doubt as to the veracity of the methods used in this study.
Other issues
The authors have used highly technical jargon and language while writing the report on the study. This cannot be cited as a real criticism since the audience for such material is people who have a strong background in medicine and related terms. It is also natural that the report is written in such a manner since it is published in a professional journal like ‘Genes, chromosomes, and cancer’. But it is quite certain that only a person with high level of technical knowledge with regard to medical science can grasp what has been written. The question that could be asked is that why should not a fairly educated person who has an interest in such research be made to understand what has been written by using a slightly more lucid style.
It is understandable that certain medical terms cannot be changed. But what is possible is that such terms and methodologies could be explained in terms that can be understood by more persons. This will definitely go a long way in educating the general public about the state of research that is going on in different parts of the world today. It can also help in disseminating information on diseases, and also the yeomen work done by researchers in helping to find cure and prevention methods for the serious and increasing killer diseases like cancer and AIDS.
The paper is peer reviewed and all claims made by the researchers with regard to prevalence of uterine leiomyoma, and also the lack of understanding of its causes.
Conclusion
A critical review of the study on cause of uterine leiomyoma as an over-expression of the high mobility proteins of the HMGA type has been done here. It is seen that the methods used by the researchers are acceptable for this kind of studies. One area of criticism is that no mention was made whether the ethnicity of the persons from whom the samples were taken. This is because ethnicity is a factor in prevalence of this condition.
The location of the study was also not mentioned though it is assumed that it was carried out in the United States. It is difficult for researchers to explain their findings in simple terms in areas like medical research. But an attempt can be made (possible by the publishers) to include a more lucid explanation of such studies for the benefit and understanding of non-technical persons.
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