Triggering of myocardial infarction by increased ambient fine particle concentration: Effect modification by source direction.

Background: Previously, we reported a 18% increased odds of ST-elevation myocardial infarction (STEMI) associated with each 7.1 µg/m(3) increase in PM2.5 concentration in the hour prior to MI onset.

Cross-Sectional Study of U.S. Interns' Perceptions of Clinical Nutrition Education.

Background Medical students have historically perceived a lack of training in clinical nutrition. Rapid advances in medical science have compelled significant changes in medical education pedagogy. It is unclear what effect this has had on student's perceptions.

Cutaneous adverse effects of targeted therapies: Part II: Inhibitors of intracellular molecular signaling pathways.

The last decade has spawned an exciting new era of oncotherapy in dermatology, including the development of targeted therapies for metastatic melanoma and basal cell carcinoma. Along with skin cancer, deregulation of the PI3K-AKT-mTOR and RAS-RAF-MEK-ERK intracellular signaling pathways contributes to tumorigenesis of a multitude of other cancers, and inhibitors of these pathways are being actively studied. Similar to other classes of targeted therapies, cutaneous adverse effects are among the most frequent toxicities observed with mitogen-activated protein kinase pathway inhibitors, PI3K-AKT-mTOR inhibitors, hedgehog signaling pathway inhibitors, and immunotherapies.

Cutaneous adverse effects of targeted therapies: Part I: Inhibitors of the cellular membrane.

There has been a rapid emergence of numerous targeted agents in the oncology community in the last decade. This exciting paradigm shift in drug development lends promise for the future of individualized medicine. Given the pace of development and clinical deployment of targeted agents with novel mechanisms of action, dermatology providers may not be familiar with the full spectrum of associated skin-related toxicities.

How to Achieve Complete and Permanent Pulmonary Vein Isolation without Complications.

The efficacy and safety of catheter ablation for the management of atrial fibrillation (AF) has been improved in recent years. Radiofrequency (RF) catheter ablation for maintaining sinus rhythm is superior to the current antiarrhythmic drug therapy in selected patients. Pulmonary vein isolation (PVI) is the cornerstone of various catheter ablation strategies.

Incremental prognostic significance of combined cardiac magnetic resonance imaging, adenosine stress perfusion, delayed enhancement, and left ventricular function over preimaging information for the prediction of adverse events.

Background: Although cardiac magnetic resonance imaging (CMR) is capable of yielding extensive data in routine practice, the relative incremental prognostic value of adenosine stress perfusion, myocardial delayed enhancement (DE), and left ventricular volumes and function is unclear.

Methods And Results: We followed up 908 consecutive patients who underwent combined CMR for suspicion of coronary stenosis and/or ischemia at 2.6 ± 1.

Impairment rating ambiguity in the United States: the Utah Impairment Guides for calculating workers' compensation impairments.

Since the implementation of workers' compensation, accurately and consistently rating impairment has been a concern for the employee and employer, as well as rating physicians. In an attempt to standardize and classify impairments, the American Medical Association (AMA) publishes the AMA Guides ("Guides"), and recently published its 6th edition of the AMA Guides. Common critiques of the AMA Guides 6th edition are that they are too complex, lacking in evidence-based methods, and rarely yield consistent ratings.

A systematic review of outcomes and quality measures in adult patients cared for by hospitalists vs nonhospitalists.

A systematic review of English-language literature was undertaken to answer the question, "Are there differences in cost or quality of inpatient medical care provided to adults by hospitalists vs nonhospitalists?" A computerized search was performed, using hospitalist and either quality, outcome, or cost as search terms. References from relevant articles were searched by hand. A standard data-extraction tool was used, and articles were included on the basis of quality and relevance.

Valvular regurgitation and surgery associated with fenfluramine use: an analysis of 5743 individuals.

Background: Use of fenfluramines for weight loss has been associated with the development of characteristic plaques on cardiac valves causing regurgitation. However, previously published studies of exposure to fenfluramines have been limited by relatively small sample size, short duration of follow-up, and the lack of any estimate of the frequency of subsequent valvular surgery. We performed an observational study of 5743 users of fenfluramines examined by echocardiography between July 1997 and February 2004 in a single large cardiology clinic.

Survival in a patient with severe paraneoplastic hyponatremia: a case report.

Background: Hyponatremia is a common and potentially life threatening problem in patients with neuroendocrine tumors.

Case Presentation: A 54-year-old female with a history of smoking and narcotic dependency presented to her primary care physician with nausea, vomiting, fatigue, malaise, ataxia and a serum sodium of 100 mEq/L. A chest computerized tomography (CT) revealed a 4.

Surgical management of anterior cruciate ligament injuries in patients with open physes.

Because of the increasing number of skeletally immature athletes who compete in highly demanding sports, more children than previously are sustaining anterior cruciate ligament injuries. Treatment and patient compliance with treatment recommendations are problematic. Pediatric issues include those specific to evaluation, projected growth, and surgery.

Examination of posterolateral corner injuries.

Physical examination of patients with a suspected posterolateral corner injury must be comprehensive. Mechanical alignment, gait, and any hyperextension or varus thrust should all be evaluated. The status of all ligaments of the knee also must be thoroughly assessed.