Hypertension update, JNC8 and beyond.

Hypertension is the most preventable major risk factor for cardiovascular morbidity and mortality. The etiology of elevated blood pressure is a complex process involving the interaction of genetics, demographics, comorbid disorders, and environmental influences. Effective hypertensive therapy has been shown to reduce cardiovascular morbidity and mortality.

Radiation-induced breast cancer: the question of early breast cancer screening in Hodgkin's lymphoma survivors.

Chest irradiation is associated with numerous early and late complications that arise from ionizing radiation-induced damage to cellular structures within the field of therapy. In patients exposed to chest irradiation at an early age as part of the treatment of childhood cancer, specifically Hodgkin's lymphoma, the increased risk of breast cancer in the long run should be considered. A case of a 35-year-old woman who exposed to chest irradiation as part of the treatment of Hodgkin's lymphoma at the age of 20 years is presented here and serves as a reminder of this somewhat overlooked complication.

Risking Life and Limb: A Case of Spontaneous Diabetic Muscle Infarction (Diabetic Myonecrosis).

Diabetic muscle infarction, also known as diabetic myonecrosis, is a microvascular complication of poorly controlled diabetes mellitus characterized by unilateral limb pain and swelling. Because these symptoms closely mimic cellulitis and thromboembolism, diagnosis is often delayed or missed altogether, leading to increased morbidity and inappropriate treatment. We describe a case of unilateral limb pain and swelling due to diabetic muscle infarction in a 36-year-old patient with poorly controlled diabetes mellitus.

Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial.

Background: Early in medical education, physicians must develop competencies needed for tobacco dependence treatment.

Objective: To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills.

Design: A group-randomized controlled trial (2010-2014) included ten U.

The relative influence of apatite crystal orientations and intracortical porosity on the elastic anisotropy of human cortical bone.

Elastic anisotropy exhibits spatial inhomogeneity in human cortical bone, but the structural origins of anatomic variation are not well understood. In this study, the elastic anisotropy of human cortical bone was predicted using a specimen-specific multiscale model that investigated the relative influence of apatite crystal orientations and intracortical porosity. The elastic anisotropy of cortical bone specimens from the diaphysis of human femora was measured by ultrasonic wave propagation as the ratio of elastic constants in the longitudinal/radial (L/R) and longitudinal/circumferential (L/C) anatomic specimen axes.

Anatomic variation in the elastic inhomogeneity and anisotropy of human femoral cortical bone tissue is consistent across multiple donors.

Numerical models commonly account for elastic inhomogeneity in cortical bone using power-law scaling relationships with various measures of tissue density, but limited experimental data exists for anatomic variation in elastic anisotropy. A recent study revealed anatomic variation in the magnitude and anisotropy of elastic constants along the entire femoral diaphysis of a single human femur (Espinoza Orías et al., 2009).

Improved accuracy of cortical bone mineralization measured by polychromatic microcomputed tomography using a novel high mineral density composite calibration phantom.

Purpose: Microcomputed tomography (micro-CT) is increasingly used as a nondestructive alternative to ashing for measuring bone mineral content. Phantoms are utilized to calibrate the measured x-ray attenuation to discrete levels of mineral density, typically including levels up to 1000 mg HA/cm3, which encompasses levels of bone mineral density (BMD) observed in trabecular bone. However, levels of BMD observed in cortical bone and levels of tissue mineral density (TMD) in both cortical and trabecular bone typically exceed 1000 mg HA/cm3, requiring extrapolation of the calibration regression, which may result in error.

Student involvement on teaching rounds.

Background: Inpatient internal medicine education occurs in a fragile learning environment. The authors hypothesized that when medical students are involved in teaching rounds, residents may perceive a decrease in value of attending teaching.

Method: During two summer periods, trained research assistants shadowed teaching rounds, tracking patient census and team call status, recording basic content of rounds, and delivering a survey instrument to the learners, asking them to rate the quality of the attending's teaching that day.

Lessons from industry: one school's transformation toward "lean" curricular governance.

As medical education grapples with organizational calls for centralized curricular oversight, programs may be compelled to respond by establishing highly vertical, stacked governance structures. Although these models offer discrete advantages over the horizontal, compartmentalized structures they are designed to replace, they pose new challenges to ensuring curricular quality and the educational innovations that drive the curricula. The authors describe a hybrid quality-assurance (QA) governance structure introduced in 2003 at the University of Kentucky College of Medicine (UKCOM) that ensures centralized curricular oversight of the educational product while allowing individualized creative control over the educational process.

The Kentucky medical curriculum: continuing innovations in educating physicians.

The University of Kentucky College of Medicine (UKCOM) retains a long history of educational commitment, quality, and innovation. Since undergoing a major curricular revision in the early 1990s, the evolving UKCOM curriculum has continued to incorporate advances in biomedical knowledge and pedagogy while meeting changing societal needs and expectations for physicians in practice. Building upon its established record of excellence in medical education, a curricular quality assurance (QA) program has been initiated to more efficiently guide improvement and innovation by providing faculty with key resources to identify and disseminate local best practices in teaching, learning, and evaluation.

Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial).

Background: Age-related macular degeneration (ARMD) is the leading cause of vision loss in aging Westem societies. The objective of the lutein antioxidant supplementation trial (LAST) is to determine whether nutritional supplementation with lutein or lutein together with antioxidants, vitamins, and minerals, improves visual function and symptoms in atrophic ARMD.

Methods: The study was a prospective, 12-month, randomized, double-masked, placebo-controlled trial conducted at an urban midwestern Veterans Administration Hospital from August 1999 to May 2001.

Urticaria, exanthems, and other benign dermatologic reactions to smallpox vaccination in adults.

A phase 1 smallpox vaccine trial involving 350 adult volunteers was conducted. Of these subjects, 250 were naive to vaccinia virus vaccine (i.e.

Serum iron, transferrin saturation, ferritin, and dietary data in age-related macular degeneration.

Iron (Fe) is a tightly metabolically controlled mineral and growth factor for all living cells. Iron not bound in erythrocyte hemoglobin is transported by the plasma iron transport protein transferrin (Tf) and bound within cells by ferritin. Apo-Tf and apo-hemopexin are also known to be made locally in the retina.

Renin Status in Association with Responsiveness to Behavioral Therapy in Hypertension.

This double-blind experiment tested the hypothesis that renin is a mediator of neurogenic hypertension. Forty-three of 46 hypertensive (mean BP 142/94) were typed for renin index and treated by combinations of group therapy (n = 32) or placebo (n = 11). A treatment effect in the therapy group resided virtually in the high/normal renin subset (21 subjects, mean drop 6/6 mm Hg, p <.