Matrix Metalloproteinase-2 and CKD Progression: The Chronic Renal Insufficiency Cohort (CRIC) Study.

Rationale & Objective: Matrix metalloproteinase 2 (MMP-2) plays an important role in the development of fibrosis, the final common pathway of chronic kidney disease (CKD). This study aimed to assess the relationship between repeated measures of MMP-2 and CKD progression in a large, diverse prospective cohort.

Study Design: In a prospective cohort of Chronic Renal Insufficiency Cohort (CRIC) participants (N = 3,827), MMP-2 was measured at baseline.

Cardiovascular Disease Events and Mortality After Myocardial Infarction Among Black and White Adults: REGARDS Study.

Background: Despite improvements in prognosis following myocardial infarction (MI), racial disparities persist. The objective of this study was to examine disparities between Black and White adults in cardiovascular disease (CVD), coronary heart disease, stroke, heart failure (HF), and mortality after MI and characteristics that may explain the disparities.

Methods: This prospective cohort study included 1122 REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants with incident MI between 2003 and 2016.

Comparison of Aggregated N-of-1 Trials with Parallel and Crossover Randomized Controlled Trials Using Simulation Studies.

N-of-1 trials offer an innovative approach to delivering personalized clinical care together with population-level research. While increasingly used, these methods have raised some statistical concerns in the healthcare community. We discuss concerns of selection bias, carryover effects from treatment, and trial data analysis conceptually, then rigorously evaluate concerns of effect sizes, power, and sample size through simulation study.

Changing rates in fracture trends are temporally associated with declining testing and treatment: reality or ecologic fallacy?

Purpose Of Review: The changing patterns of osteoporosis treatment and fragility fractures have led to what leaders are calling a 'crisis in the osteoporosis.' We address data on changing patterns in fractures, and highlight strengths and limitations of recently published data.

Recent Findings: Declines in hip fracture rates have been shown in studies from around the world.

Gut microbiota diversity is associated with cardiorespiratory fitness in post-primary treatment breast cancer survivors.

New Findings: What is the central question of this study? Does the link between cardiorespiratory fitness and gut microbiota diversity persist after adjusting for the potential effects of percentage body fat and activity-related energy expenditure (AEE)? What is the main finding and its importance? This is the first study to examine the link between cardiorespiratory fitness and gut microbiota diversity while accounting for the underlying effects of percentage body fat and free-living AEE. Results from the present work suggest that cardiorespiratory fitness, not physical activity, is a superior correlate of gut microbiota diversity among post-primary treatment, non-metastatic breast cancer survivors.

Abstract: Cancer treatment uniquely triggers multiple physiological shifts detrimental to overall health.

Hyperaldosteronism: the internist's hypertensive disease.

Primary aldosteronism (PA) is a disorder typically characterized by resistant hypertension, hypokalemia, alkalosis and suppressed plasma renin activity, and excessive aldosterone production. A true estimate of the prevalence of the disorder is difficult to estimate because its detection is dependent on the awareness of the healthcare provider to the disorder, but it has generally been felt to be a rare occurrence. Its frequency of detection began to change when Hiramatsu suggested calculating the ratio of plasma aldosterone/plasma renin activity as a screening tool for the disorder.

Disability examinations: a look at the Social Security Disability Income System.

Disability income protection is an important part of a worker's safety net. U.S.

Malpractice risk prevention for primary care physicians.

The recent medical malpractice "crisis" has seen skyrocketing liability premiums and increasing fear of liability. Primary care physicians, especially family medicine and internal medicine physicians, have historically experienced low rates of malpractice claims, both in number and amount of payment. This can be attributed to several factors: the esteem held by internal medicine and family medicine physicians in their communities, relatively low numbers of invasive procedures, reluctance of patients to include "their" primary care physician in any potential litigation, and, probably most importantly, the atmosphere of mutual trust and communication between the internist or family physician and the patient.

Quality of care in diabetes: understanding the guidelines.

We are in the midst of a global pandemic of diabetes. Despite the increasing burden of the disease, measurements of quality repeatedly show poor adherence to or implementation of current guidelines for diabetes care. This article will provide a brief review of the most significant randomized controlled clinical trials relevant to the current guidelines and then discuss essential treatment goals and the evidence that supports them.

Caring for adolescent family members of physician colleagues.

It is recommended that physicians do not care for their family members. However, there are also many concerning issues when physicians care for the family members of their colleagues. This can be particularly challenging when the patient is an adolescent.