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Regrowing bone naturally

Posted: 04 Jan 2014 08:00 AM PST

Bioengineers and surgeons have been making waves in bone tissue engineering, allowing them to heal and regrow broken bones without the need for bone grafts or metal plates.

Early last year, 18-year-old Nikita (not her real name) was seriously injured in a car accident in India that killed both her parents.

The Indian teenager's skull was shattered in the crash and she had a large, palm-size hole in her skull. A desperate uncle took her to neurosurgeon Sharan Srinivasan in Bangalore.

Dr Srinivasan took one look at the injury and called materials engineer Prof Teoh Swee Hin in Singapore, an expert in coaxing bone to grow back on biodegradable bone plugs and scaffolds.

Prof Teoh, now at Nanyang Technological University, and his team put together a spider-web like titanium frame, which held in place sheets of flexible, biodegradable scaffolds infused with Nikita's own bone marrow.

Besides producing red blood cells and some white blood cells, bone marrow also contains the cells that are, or will turn into, the main component of bone.

Now, a year and a half on, the hole in Nikita's skull has healed. "I went to Bangalore in August, a year after the surgery, and I could not recognise her," Prof Teoh said.

Around the world, there have been about 10 such cases in the past three years, Prof Teoh said.

Bone tissue engineering is used to help patients who have lost bone to cancer – in accidents, or in some types of brain surgery which involve drilling holes in the skull - to regrow and remodel damaged bone. The technology, which started a decade ago with producing tiny bone plugs the size of a five-cent coin, has now advanced to a stage where it could provide a safer, less painful treatment for people who have larger areas of bone damage.

Experts from Singapore and around the world were in town for the sixth Bone Tissue Engineering Congress, or Bone-Tec, at Nanyang Technological University earlier this month.

At the congress, Prof Teoh presented a surprising new finding: Bone grew back most where the curved titanium frame was exerting force on the surrounding area.

It is not clear exactly why bone growth follows these lines of force, although doctors have long known that bone needs stresses such as weight-bearing exercise for bone health, Prof Teoh said.

"In Nikita's case, we won't know till five years later whether the bone is hard enough; we hope that it will continue to remodel and in due time it'll be almost perfect."

Regrown bone has other benefits, he added. When large titanium plates or pieces are used, the patient's body may reject them, and there is a risk of infection about three to four years later.

Dr Goh Bee Tin of the National Dental Centre has used Prof Teoh's biodegradable plastic scaffolds to repair the jaws of about 20 patients.

Currently, patients have their own bone grafted from a hip or leg, but this means extra surgery and pain, Dr Goh said.

Other work in bone tissue engineering revolves around improving the biodegradable scaffolds.

National University of Singapore doctoral student Wang Zuyong and colleagues from other universities and hospitals here found that stretching a thin plastic film created tiny grooves that aligns stem cells as they develop, helping nerves and vessels to grow true.

The plastic film is made of the same polycaprolactone material as the fine-meshed scaffold sheets or pieces, and will also degrade as tissue grows.

At the same time, Prof Teoh and his colleagues developed a bioreactor that spins on two axes, rather than the conventional reactors that spin on one axis like a roast on a spit. They found that bone grown using the bioreactor that spins on two axes is stronger and has fewer dead cells, as such bioreactors mimic the mechanical forces present in the body.

Now, the two-axis bioreactor technology has been licensed to home-grown start-up QuinXell Technologies.

Still, others work at the level of cells. Professor Charles James Kirkpatrick of the Johannes Gutenberg University in Germany, who presented at the congress, studies how bone cells "talk" to their surrounding environment when they are implanted, to encourage blood vessels to grow in and through the bone to feed it with nutrients and oxygen.

And at the Agency for Science, Technology and Research's Institute of Medical Biology, Dr Simon Cool and Dr Victor Nurcombe study how sugars called heparan sulfates control cell growth.

Heparan sulfate-treated scaffolds could be used instead of putting large doses of growth factors straight into patients' bodies, which some studies have shown to carry the risk of tumours.

While simply implanting or transplanting bone is relatively straightforward, the challenge facing researchers is to remodel bone and get blood vessels and nerves to regrow accurately, Prof Teoh said.

Fukushima struggles to recover

Posted: 04 Jan 2014 08:00 AM PST

Post-tsunami reconstruction and radiation clean-up could take 10 years, but officials say something has been permanently lost.

Nearly three years after a major earthquake, tsunami and nuclear radiation leak devastated coastal and inland areas of Japan's Fukushima prefecture, 281km north-east of Tokyo, Namie has become a silent town of ghosts and absent lives.

Namie's 21,000 residents remain evacuated because of continuing high radiation levels, the product of the March 2011 disaster at the Fukushima Daiichi nuclear power station, 9.6km to the south. Homes, shops and streets are deserted except for the occasional police patrol or checkpoint.

Like the setting for a Hollywood post-apocalypse movie, grass and weeds poke up through cracked pavements. At an abandoned garage, a rusting car sits on a raised ramp, waiting for a repair that will never be completed. A feral dog peers from a wild, untended garden.

Namie is nobody's town now. Nobody lives here, and nobody visits for long. Even the looters have stopped bothering, and no one knows exactly when the inhabitants may be allowed to return permanently – or whether they will want to.

The 2011 catastrophe faded from world headlines long ago, but in Namie, Tomioka, Okuma, Futaba and other blighted towns in the 32km evacuation zone around the Fukushima plant, it is a disaster that never ends.

At the plant itself, recent leaks of contaminated water into the sea and a fraught operation to remove fuel rods from one of the damaged reactors have shown how critical the situation still is – and will remain during a decommissioning process that could take up to 40 years.

For Fukushima's displaced population, the effects of the disaster continue to be deeply felt. The evacuation area was subdivided earlier this year into three zones of higher or lower radiation risk. In the worst affected zone, return will not be allowed before 2017 at the earliest.

In other areas, families and businesses face difficult decisions about whether or not to go back. At present, no one is even allowed to stay overnight. Locals say that whatever happens, many younger people will not return.

There is little or no trust in official pronouncements, given the failure of the Fukushima Daiichi operator, Tokyo Electric Power Company (Tepco), to take adequate measures to protect the plant against the tsunami and the company's unimpressive post-disaster record.

There are suspicions that the government knows some towns may never be safe to live in again, but refuses to admit it in order to protect Japan's unpopular nuclear power industry. There is also a sense that Fukushima's victims have been forgotten.

That said, the painstaking cleanup continues and there has been some progress in adjoining, less badly affected areas, according to Hiroshi Murata, the head of the Odaka ward of Minamisoma City, close to Namie.

As many as 18,000 people died or were declared missing in Fukushima prefecture after the tsunami struck. The radiation plumes caused the forced evacuation of a further 154,000, according to the Japan Reconstruction Agency.

In Odaka, 148 people died, and there were more than 300 fatalities in Minamisoma as a whole. But now around 53% of Odaka residents have returned home, a total of 6,800 out of a pre-disaster population of 12,800, Murata said.

Nobody has died directly as a result of the nuclear disaster, but a close eye is being kept on the incidence of thyroid cancer in children, following the experience of Chernobyl.

The biggest issues the local administration now faces, following the rehousing of residents in temporary accommodation, are the demolition of unsafe houses, replacement of infrastructure and services, including roads and school playgrounds, and the decontamination and desalination of buildings and land.

"To decontaminate one house and garden takes 10 to 14 days," Murata said. "We have to remove surface soil, cut the trees, wash the roofs, clean the rain gutters. The house owners are responsible for cleaning inside. The city and the government help with the rest."

At least in Odaka there is something to clean and repair. In Ukedo, the part of Namie municipality closest to the Pacific ocean, the devastation is total. Hardly a single house was left standing by the tsunami, which reached 17m in height in some places, Murata said – a vast wall of water that devoured all in its path.

Wrecked fishing boats still lie stranded miles inland and there are vast piles of scrap metal, smashed cars, bits of concrete bridges and broken wooden house frames where once a thriving village stood. An abandoned elementary school, 500m from the sea, looks as though it has been bombed.

But even in Ukedo, a long line of displaced local resident volunteers can be seen picking up and sorting debris on a wintry afternoon, gradually clearing the land where homes formerly stood. With impressive organisation, the local authorities are recycling everything they can, bagging it up in vast compounds erected amid the bleak, salty flatlands that were once rice paddy fields.

Tetsurou Eguchi, the deputy mayor of Minamisoma City, said the radiation-related cleanup was likely to take another five to six years and could cost as much as ¥350bil, much of which would come from the national government. Post-tsunami reconstruction would take up to 10 years. But something intangible had been permanently lost, he said.

"When it comes to the economy, and individual and social life, it is very difficult to recover this, compared with how it used to be."

The most challenging problem, he said, was decontamination. "Basically (the radioactive fallout) is not in the air any more. It's in the soil."

The area was dependent economically on small businesses, agriculture, fishing and tourism, including the famous annual Soma Nomaoi samurai festival, he said. All had been seriously affected.

"People don't believe it is safe to visit here. They won't believe our produce, our livestock, our fish are safe. There is a blight. This will take a long time to change."

Much had been said by the national government about supporting Fukushima prefecture in its efforts to get back on its feet, but the reality is different, Eguchi said.

"It is a fact that we have received quite a lot of support, but is it sufficient? That is difficult, because it's not just a question of reconstruction. Politicians in Tokyo say if Fukushima does not recover, Japan will not recover, but I'm not sure they really mean that.

"I don't think Fukushima is fully supported by the whole country. And that's what the citizens here think." — Guardian News & Media 2014

Food scandals and political fights: Taiwan's year of the fake

Posted: 04 Jan 2014 08:00 AM PST

Based on Facebook selfies, food safety issues and political battles within and between the political parties, people chose a perfect word to describe Taiwan in 2013: fake. It was a confusing year for the people of Taiwan.

We cannot trust the labels on packages of food, and we cannot trust politicians when they say they are always thinking about the people.

The award-winning documentary Beyond Beauty, released toward the end of 2013, shows the audience the beauty of Taiwan, and also the hidden ugliness of the island. What did people go through and learn from the year of fake?

In 2013, well-known bakery chain store Top Pot Bakery, which claimed to use all-natural ingredients, was exposed for putting artificial flavouring in their bread. Following the scandal, another issue about cooking oil arose. It turned out that many oil manufacturers intentionally mislabelled low-cost cooking oil as olive oil.

People thought that they could trust the labels on products, and believed in major food manufacturers. They were all disappointed after the scandals broke.

Food sellers intentionally mislabelled products so they could lower the cost and earn more profit, and they bet on the fact that most people use the product without questioning it. Most people love beautiful exteriors, and they don't care what the manufacturers does to provide a shining appearance.

The field of politics is always one of the most confusing and complicated of places. In 2013, we witnessed the legislative speaker being accused of involvement in a month-long spectacle involving the Democratic Progressive Party caucus whip, an incident which later transformed into a battle between Wang Jin-pyng and President Ma Ying-jeou.

Taiwan watched these performances by politicians from all parties, and even though the Legislative Yuan cleared Wang of the accusation of illegal lobbying, people were still confused. We are left wondering how the legislators and politicians could focus on fighting for the citizens' benefit when they are so busy fighting each other. And that question was based on the assumption that those battles between politicians were real.

In the documentary Beyond Beauty, audiences were stunned by the beauty of Taiwan that had been overlooked, but they were also shocked by the pollution and destruction that is taking place. Rivers were turned the colour of desperation and trees were replaced by illegally constructed buildings. If the director and camera crew could capture these true images and present them to audiences, how can people with the authority to make a difference pretend like nothing is happening?

The truth is, most people who have political power spend most of their time trying to maintain that power instead of being concerned for the public. They always wait until the media or the public unwrap the ugly truth hidden inside shining packages to start acting.

The Ministry of Health and Welfare started massive inspections and proposed amendments to increase punishments for food sellers who mislabel products after the cooking oil scandal was revealed. Kaohsiung City's Environmental Protection Bureau started to crack down on factories that dumped wastewater into rivers illegally after the public was shocked by the colour of the Hou-chin River.

The Ministry of the Interior began to look into illegally operated hostels at Cingjing Farm after the documentary Beyond Beauty showed the nation the potential hazard those hostels could bring to the area.

Sometimes, a certain level of fake can bring no harm to anyone, just like lengthening a model's legs with Photoshop cannot hurt people who see the image.

However, it does leave people with a false impression and keeps people from seeing the truth. With all the fake information from food labels, "entertaining" performances from politicians, and shocking footage from Beyond Beauty in 2013, people in Taiwan can still have some hope for 2014. If not, at least they have learned how to fake it.


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