Kar challenges doctors to consider why we chose medicine and what motivates us to continue.1 He offers insight as to his reasons but leaves more questions than answers.Family influence contributed to…
Showcasing the brightest minds from Australia and beyond: come to Melbourne for Sports Medicine Australias annual conference (14-17 October 2020)
Sports Medicine Australia (SMA) is excited to announce that our 2020 annual conference is returning to Melbourne, the home of Australian rules football (figure 1). Fittingly, we begin this SMA British Journal of Sports Medicine (BJSM) edition by highlighting the
Response Rate and Nonresponse Bias in Oncology Survey Studies
No abstract available
[Editorial] COVID-19: global consequences for oncology
As the coronavirus disease 2019 (COVID-19) pandemic escalates and countries struggle to contain the virus, health-care systems are under increasing pressure. Emergency departments and intensive care units are nearing breaking point, and medical resources are being diverted to tackle the
The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years
Abstract Lack of health insurance coverage is strongly associated with poor cancer outcomes in the United States. The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end‐of‐life care than their
Stepwise selection on homeologous PRR genes controlling flowering and maturity during soybean domestication
Nature Genetics, Published online: 30 March 2020; doi:10.1038/s41588-020-0604-7 Whole-genome resequencing and association analyses in 424 soybean accessions identify two homeologous genes that contributed to flowering time adaptation during soybean domestication.
Managing Stable Ischemic Heart Disease
The preferred contemporary approach to the management of stable ischemic heart disease, also referred to as chronic coronary syndrome, is not well defined. Two strategies are commonly used. The conservative strategy uses guideline-based medical therapy, including antianginal drugs as well
Managing Stable Ischemic Heart Disease
The preferred contemporary approach to the management of stable ischemic heart disease, also referred to as chronic coronary syndrome, is not well defined. Two strategies are commonly used. The conservative strategy uses guideline-based medical therapy, including antianginal drugs as well
Health benefits of policies to reduce carbon emissions
In June 2019 the UK legally committed to cut emissions of carbon dioxide and other greenhouse gases to net zero by 2050.1 To reach this target the Committee on Climate Change says that a rapid…
Acknowledgment
Anticoagulant Therapy for Venous Thromboembolism in Cancer
Direct oral anticoagulants were introduced for the treatment for acute venous thromboembolism just over a decade ago. Unlike warfarin, these drugs are given in fixed doses and do not require laboratory monitoring of the anticoagulant effect. Although direct oral anticoagulants
Anticoagulant Therapy for Venous Thromboembolism in Cancer
Direct oral anticoagulants were introduced for the treatment for acute venous thromboembolism just over a decade ago. Unlike warfarin, these drugs are given in fixed doses and do not require laboratory monitoring of the anticoagulant effect. Although direct oral anticoagulants
Covid-19: Doctors are told not to perform CPR on patients in cardiac arrest
Healthcare staff in the West Midlands have been told not to start chest compressions or ventilation in patients who are in cardiac arrest if they have suspected or diagnosed covid-19 unless they are…
Intraoperative Tranexamic Acid to Decrease Blood Loss During Myomectomy: A Randomized Double-Blind Placebo Controlled Trial
Myomectomy is associated with a significant risk of hemorrhage. Tranexamic acid is a synthetic lysine derivative with antifibrinolytic activity used in other surgical disciplines to reduce blood loss during surgery. However, its utility in gynecologic surgery is not well understood.
Preexcited Atrial Fibrillation after a Blood Draw
Figure 1.
Undocumented U.S. Immigrants and Covid-19
In 2019, as the “public charge” rule made its way through the U.S. court system, many low-income immigrant parents of American children in the Johns Hopkins pediatric practice asked our case managers to disenroll their children from the Supplemental Nutrition
Undocumented U.S. Immigrants and Covid-19
In 2019, as the “public charge” rule made its way through the U.S. court system, many low-income immigrant parents of American children in the Johns Hopkins pediatric practice asked our case managers to disenroll their children from the Supplemental Nutrition
Case 10-2020: An 83-Year-Old Man with Pancytopenia and Acute Renal Failure
Presentation of Case. Dr. Christian C. Mewaldt (Medicine): An 83-year-old man was transferred to this hospital because of pancytopenia and acute renal failure. Five days before this presentation, the patient was found conscious on his bedroom floor; he had been
[Editorial] COVID-19: learning from experience
Over the past 2 weeks, the coronavirus disease 2019 (COVID-19) pandemic has marched relentlessly westward. On March 13, WHO said that Europe was now the centre of the pandemic. A few days later, deaths in Italy surpassed those in China.
Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months
Sciatica that is caused by acute herniation of a lumbar disk is expected to improve with conservative care in 90% of patients within 4 months after the onset of symptoms. Several randomized trials involving patients with acute sciatica have shown
Covid-19: what do trainees need to know?
I’m in training, am I likely to be redeployed to another department?This is an unprecedented situation for the NHS and it’s likely that many staff, including junior doctors, will be asked to take on…
Highlights from this issue
This month’s Airwaves takes its cue from the “Good Vibrations” editorial on page 296, to bring you a musically themed Airwaves. Our editorial highlights with segue effortlessly from respiratory medicine to the “Rock and Roll” Hall of Fame and back
Activating Immunity to Fight a Foe — A New Path
The discovery of antibiotics is perhaps the single most important advance in medicine in the past century. However, the emergence of multidrug-resistant pathogens has rendered many antibiotics ineffective and is fueling a crisis: a dramatically increased incidence of infections refractory
Endometriosis
Endometriosis is defined as the presence of endometrium-like tissue outside the uterus. However, this definition does not encompass the complex symptomatic, pathobiologic, and multisystemic nature of the disorder (Figure 1). Endometriosis is primarily diagnosed through surgical visualization —…
Activating Immunity to Fight a Foe — A New Path
The discovery of antibiotics is perhaps the single most important advance in medicine in the past century. However, the emergence of multidrug-resistant pathogens has rendered many antibiotics ineffective and is fueling a crisis: a dramatically increased incidence of infections refractory
Polymer-based or Polymer-free Stents in Patients at High Bleeding Risk
Contemporary drug-eluting stents are the standard of care for patients undergoing percutaneous coronary intervention (PCI). Nearly one third of patients treated with PCI are considered to be at high bleeding risk and are frequently excluded from stent trials. Short durations
Defining the Epidemiology of Covid-19 — Studies Needed
The epidemic of 2019 novel coronavirus (now called SARS-CoV-2, causing the disease Covid-19) has expanded from Wuhan throughout China and is being exported to a growing number of countries, some of which have seen onward transmission. Early efforts have focused
[Editorial] COVID-19, a pandemic or not?
The current outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread, and as of March 11, 2020, it has reached 115 countries, with 119 239 cases and 4287 deaths. In January,
Misguided Changes to SNAP — Defending a Public Health Intervention for the Poor
On April 1, 2020, the Trump administration plans to implement the first in a series of three proposed changes to the Supplemental Nutrition Assistance Program (SNAP), the federal safety-net program formerly known as “food stamps.” More than 36 million Americans,
Suicide — Rewriting My Story
Intern year is a marathon. It’s an analogy I’ve heard often, and one that resonates with the runner in me. Both intern year and marathons have a way of revealing vulnerabilities and breaking even the strongest among us. Overwhelmed by
Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017
AbstractObjectiveTo use data from the Global Burden of Disease Study between 1990 and 2017 to report the rates and trends of point prevalence, annual incidence, and years lived with disability for…
Heartbeat: risk of stroke in patients with heart failure
In patients with heart failure (HF), the increased risk of ischaemic stroke often is attributed to coexisting atrial fibrillation (AF). To test the hypothesis that there is a higher risk of ischaemic stroke in patients with HF, even in the
Appointment of E. Albert Reece as Editor of Diabetes, Obesity and Metabolism during Pregnancy for AJOG
E. Albert Reece, MD, PhD, MBA, has been appointed Associate Editor of Diabetes, Obesity, and Metabolic Disorders during Pregnancy for the American Journal of Obstetrics & Gynecology (AJOG).
Regulating Vaping — Policies, Possibilities, and Perils
Smoking rates peaked in the United States in the mid 1960s and have since declined to historically low levels. In contrast, use of e-cigarettes has recently soared, particularly among young people. In 2019, more than 27% of high school students
Novel Coronavirus and Old Lessons — Preparing the Health System for the Pandemic
How sad that the people who remember the last major pandemic — influenza in 1968 — are the primary victims of today’s. How sad that despite the many medical advances that have been made since then — critical care, extracorporeal
Regulating Vaping — Policies, Possibilities, and Perils
Smoking rates peaked in the United States in the mid 1960s and have since declined to historically low levels. In contrast, use of e-cigarettes has recently soared, particularly among young people. In 2019, more than 27% of high school students
Regulating Vaping — Policies, Possibilities, and Perils
Smoking rates peaked in the United States in the mid 1960s and have since declined to historically low levels. In contrast, use of e-cigarettes has recently soared, particularly among young people. In 2019, more than 27% of high school students
Interpreting test results: don’t blame the tools
McCormack and Holmes discuss the imprecision of medical measurements and suggest a method for estimating variation in test results.1 Byron’s paraphrased proverb, “Good workmen never quarrel with…
[Editorial] The evolving role of stem cell transplantation
Since the 1950s, haematopoietic stem-cell transplantation (HSCT) has proliferated as a technique and has led to 1 million transplantations worldwide. HSCT is often the only established curative treatment for selected patients with congenital or acquired disorders and is routinely used
The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years
Abstract Lack of health insurance coverage is strongly associated with poor cancer outcomes in the United States. The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end‐of‐life care than their
Retinal Detachment in X-Linked Retinoschisis
Figure 1.
Fair Allocation of Scarce Medical Resources in the Time of Covid-19
Covid-19 is officially a pandemic. It is a novel infection with serious clinical manifestations, including death, and it has reached at least 124 countries and territories. Although the ultimate course and impact of Covid-19 are uncertain, it is not merely
Hundreds of Health Care Workers Exposed to Rabies
A Utah man who became infected with rabies after handling several bats potentially exposed 279 other people, most of them health workers.
The Toughest Triage — Allocating Ventilators in a Pandemic
The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the
Decision Making for Treatment of Persistent Sciatica
Lumbar disk herniations are among the most frequent causes of sciatica. Fortunately for patients, sciatica is generally self-limited and resolves within 3 months in 70 to 90% of patients. When symptoms do not improve, surgical diskectomy has been an accepted
Do PCSK9 inhibitors do anything more than reduce LDL cholesterol?
Byrne and colleagues point out the lack of reliable evidence on cardiovascular risk with inclisiran, and the omens are not good.1Inclisiran undoubtedly has a marked lowering effect on low density…
Risk factors and a 3-month risk score for predicting pacemaker implantation in patients with atrial fibrillations
Objectives To identify risk factors and to develop a predictive risk score for pacemaker implantation in patients with atrial fibrillation (AF). Methods Using Danish nationwide registries, patients with newly diagnosed AF from 2000 to 2014 were identified. Cox proportional-hazards regression
Highlights from this issue
Altered ellipsoid zone reflectivity and deep capillary plexus rarefaction correlate with progression in best disease (see page 461) Patients in the vitelliform stage of Best disease show significant ellipsoid zone and vascular alterations at deep capillary plexus. The severity of
Risk of metastatic pheochromocytoma and paraganglioma in SDHx mutation carriers: a systematic review and updated meta-analysis
Background Pheochromocytoma and paraganglioma (PPGL) are tumours that arise from chromaffin cells. Some genetic mutations influence PPGL, among which, those in genes encoding subunits of succinate dehydrogenase (SDHA, SDHB, SDHC and SDHD) and assembly factor (SDHAF2) are the most relevant.
Festina Lente
This Latin, and before that Greek, adage (perhaps more recognisable in the form of its English equivalent ‘More haste less speed’) has stood the test of time. Speed is a known determinant of road crash death. The maximum vehicle travel
Targeting apoptosis in cancer therapy
Nature Reviews Clinical Oncology, Published online: 23 March 2020; doi:10.1038/s41571-020-0341-y The authors of this Review present the main pathways that regulate apoptosis as well as other signalling pathways that interact with them, highlighting actionable molecular targets for anticancer therapy. They
Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy
The current coronavirus disease 2019 (COVID-19) pneumonia pandemic, caused by the severe acute respiratory syndrome 2 (SARS-CoV-2) virus, is spreading globally at an accelerated rate, with a basic reproduction number (R0) of 2 – 2.5, indicating that 2 – 3
Genomic characterization of human brain metastases identifies drivers of metastatic lung adenocarcinoma
Nature Genetics, Published online: 23 March 2020; doi:10.1038/s41588-020-0592-7 Whole-exome sequencing of human brain metastases from lung adenocarcinoma uncovers new drivers by comparison of somatic alteration frequencies in brain metastasis cases to those in primary lung adenocarcinomas.
Fair Allocation of Scarce Medical Resources in the Time of Covid-19
Covid-19 is officially a pandemic. It is a novel infection with serious clinical manifestations, including death, and it has reached at least 124 countries and territories. Although the ultimate course and impact of Covid-19 are uncertain, it is not merely
The Toughest Triage — Allocating Ventilators in a Pandemic
The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the
The Toughest Triage — Allocating Ventilators in a Pandemic
The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the
Pharmacists and assisted dying
The UN General Assembly has emphasised that the right to freedom of thought, conscience, and religion or belief applies equally to all people, regardless of their religion or belief and without any…
Hereditary Angioedema
Hereditary angioedema is a rare, potentially life-threatening disorder characterized by attacks of cutaneous and submucosal swelling. Quincke first described its clinical presentation, and Osler’s recognition of the autosomal dominant inheritance pattern followed in 1888. The initial name of the…
Covid-19 mass testing facilities could end the epidemic rapidly
In Editor’s Choice of 19 March Godlee mentions the urgent need for increased capacity to test frontline healthcare workers serologically to verify their immunity to the covid-19 virus.[1] Even more…
Ejection fraction to classify heart failure: are we using the right thing?
Hereditary Angioedema
Hereditary angioedema is a rare, potentially life-threatening disorder characterized by attacks of cutaneous and submucosal swelling. Quincke first described its clinical presentation, and Osler’s recognition of the autosomal dominant inheritance pattern followed in 1888. The initial name of the…
Opioid Prescribing in the Midst of Crisis — Myths and Realities
The once-simple act of writing an opioid prescription has become fraught. Physicians must check prescription monitoring databases to review patients’ histories, make sure their prescription complies with state limits on dose or number of days’ supply, and consider any practice-quality
Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months
Sciatica that is caused by acute herniation of a lumbar disk is expected to improve with conservative care in 90% of patients within 4 months after the onset of symptoms. Several randomized trials involving patients with acute sciatica have shown
Deciphering the impact of enhancer variation
Nature Reviews Genetics, Published online: 20 March 2020; doi:10.1038/s41576-020-0230-3 A study in Cell describes a novel, highly scalable CRISPR–Cas9-based assay and its use in assessing the role of enhancer mutations in mammalian limb development.
Hereditary Angioedema
Hereditary angioedema is a rare, potentially life-threatening disorder characterized by attacks of cutaneous and submucosal swelling. Quincke first described its clinical presentation, and Osler’s recognition of the autosomal dominant inheritance pattern followed in 1888. The initial name of the…
Universal Disease Screening and Treatment — The Egyptian Example
Thirty years ago, chronic conditions such as diabetes, heart disease, and obesity accounted for less than 45% of the global disease burden. Today, they are the leading causes of death and disability worldwide, having surpassed infectious diseases such as HIV/AIDS
Hereditary Angioedema
Hereditary angioedema is a rare, potentially life-threatening disorder characterized by attacks of cutaneous and submucosal swelling. Quincke first described its clinical presentation, and Osler’s recognition of the autosomal dominant inheritance pattern followed in 1888. The initial name of the…
Case 9-2020: A 64-Year-Old Man with Shortness of Breath, Cough, and Hypoxemia
Presentation of Case. Dr. Ryan J. Sullivan: A 64-year-old man presented to this hospital for evaluation of a mass in the left frontal and left parietal lobes. Four weeks before this presentation, while residing at his home in Florida, the
Covid-19 and the Stiff Upper Lip — The Pandemic Response in the United Kingdom
For many weeks, the British instinct to “Keep Calm and Carry On” was the public face of the U.K. government’s response to Covid-19. Policies were to be “based on the science,” with an initial focus on containment, involving identification of
Covid-19 and the Stiff Upper Lip — The Pandemic Response in the United Kingdom
For many weeks, the British instinct to “Keep Calm and Carry On” was the public face of the U.K. government’s response to Covid-19. Policies were to be “based on the science,” with an initial focus on containment, involving identification of
Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients
The practice of sedating patients receiving mechanical ventilation has been standard care. Although advances in technology have made modern ventilators more comfortable for patients, it has generally been believed that light sedation should accompany mechanical ventilation. However, trials…
[Editorial] Send in the therapists?
Public health emergencies, such as coronavirus disease 2019 (COVID-19) and the bush fires in Australia, highlight the inequalities in our societies and the failures of our institutions. The poor suffer the brunt of any new pandemic, earthquake, or flood, while
Covid-19: control measures must be equitable and inclusive
The global spread of covid-19 has generated aggressive medical and public health responses, including testing, screening, contact tracing, social distancing, travel restrictions, and orders to stay…
Highlights from this issue
Achieving the right care The Right Care Alliance (RCA) is a US based coalition of clinicians, patients and community members who aim to achieve the best healthcare outcomes at the fairest price without any over diagnosis, investigation or treatment. In
Challenges in molecular diagnosis of Wilson disease
A holistic approach is still required for the diagnosis of Wilson’s disease The study by Poon et al1 outlines the issues associated with the use of current molecular diagnostic methodologies to rule in or rule out a diagnosis of Wilson’s
Case 9-2020: A 64-Year-Old Man with Shortness of Breath, Cough, and Hypoxemia
Presentation of Case. Dr. Ryan J. Sullivan: A 64-year-old man presented to this hospital for evaluation of a mass in the left frontal and left parietal lobes. Four weeks before this presentation, while residing at his home in Florida, the
Retinal Detachment in X-Linked Retinoschisis
Figure 1.
GRACE score and cardiovascular outcomes prediction among the delayed coronary intervention after post-fibrinolytic STEMI patients in a limited PCI-capable hospital
Background In Thailand, due to limited availability of percutaneous coronary intervention (PCI)-capable hospitals, a number of patients with ST-elevation myocardial infarction (STEMI) after fibrinolytic therapy underwent the delayed coronary intervention (24 hours to 2 weeks). Existing tool such as the
Responses in 16 Cases of Nummular Eczema.
Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia
Heterozygous familial hypercholesterolemia, a genetic disorder that affects 1 in 250 persons or 30 million people worldwide, is characterized by elevated levels of low-density lipoprotein (LDL) cholesterol from birth. Without treatment, the condition is associated with premature complications and…
Opioid Prescribing in the Midst of Crisis — Myths and Realities
The once-simple act of writing an opioid prescription has become fraught. Physicians must check prescription monitoring databases to review patients’ histories, make sure their prescription complies with state limits on dose or number of days’ supply, and consider any practice-quality
Clinical and Laboratory Data on 12 Patients with Cirrhosis of the Liver.
SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients
To the Editor: The 2019 novel coronavirus (SARS-CoV-2) epidemic, which was first reported in December 2019 in Wuhan, China, and has been declared a public health emergency of international concern by the World Health Organization, may progress to a pandemic
Effect of Dilantin Therapy on Pulse and Temperature.
Reducing Treatment Burden in AMD
VEGF-A antagonists have revolutionized wet AMD treatment. Several challenges remain including high treatment burden requiring repeated intraocular injections for persistent disease. Brolucizumab directly inhibits VEGF-A function, providing visual outcomes comparable to aflibercept (an FDA-approved VEGF-A antagonist). Anatomic retinal outcomes including
[Editorial] Peace and health in Afghanistan
After years of war and political instability, Afghanistan is at a potentially historic crossroads. On Feb 29, 2020, a peace deal was agreed between the Taliban and the USA. The anticipated resumption of talks between the Afghan Government and the
Selumetinib in Children with Inoperable Plexiform Neurofibromas
Neurofibromatosis type 1, an autosomal dominant genetic disorder characterized by multiple progressive tumor and nontumor manifestations, has limited treatment options. In patients with the disorder, dysfunction of the guanosine triphosphatase–activating protein neurofibromin leads to…
Clinic Diagnoses of Presenting Complaints in 50 Patients.
Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients
The practice of sedating patients receiving mechanical ventilation has been standard care. Although advances in technology have made modern ventilators more comfortable for patients, it has generally been believed that light sedation should accompany mechanical ventilation. However, trials…
Decision Making for Treatment of Persistent Sciatica
Lumbar disk herniations are among the most frequent causes of sciatica. Fortunately for patients, sciatica is generally self-limited and resolves within 3 months in 70 to 90% of patients. When symptoms do not improve, surgical diskectomy has been an accepted
Flying high
#Time2Act: Harassment and abuse in elite youth sport culture
“After months of dieting and frustration, Cain found herself choosing between training with the best team in the world, or potentially developing osteoporosis or even infertility. She lost her period for 3 years and broke five bones. She went from
The burning building
With the covid-19 pandemic, we have entered extraordinary times, when some things are known but many more are not and where decisions must be made nonetheless.The UK government’s recent actions…
Highlights from this issue
Unpredictability ‘The world is so unpredictable. Things happen suddenly, unexpectedly… We want to feel we are in control of our own existence. In some ways we are, in some ways we’re not. We are ruled by the forces of chance
‘To switch or not to switch: the missing piece in the puzzle of biosimilar literature?
We read with great interest the paper from Glintborg and coauthors ‘To switch or not to switch’ reporting biosimilar etanercept switching in Denmark.1 In the Danish Biologic (DANBIO) cohort, patient treated with originator etanercept (Enbrel) were informed of a mandatory
Placenta Accreta Spectrum: Biomarker Discovery using Plasma Proteomics
Many cases of placenta accreta spectrum (PAS) are not diagnosed antenatally, despite identified risk factors and improved imaging methods. Identification of plasma protein biomarkers could further improve antenatal diagnosis of PAS.
Selumetinib in Children with Inoperable Plexiform Neurofibromas
Neurofibromatosis type 1, an autosomal dominant genetic disorder characterized by multiple progressive tumor and nontumor manifestations, has limited treatment options. In patients with the disorder, dysfunction of the guanosine triphosphatase–activating protein neurofibromin leads to…
Transcriptional profiling of physically interacting cells
Nature Reviews Genetics, Published online: 18 March 2020; doi:10.1038/s41576-020-0229-9 A new technology, named PIC-seq, combines cell sorting of physically interacting cells (PICs) with single-cell RNA sequencing and computational modelling to profile cellular interactions and their impact on gene expression.
Vitamin D Supplementation during Pregnancy and the Prevention of Childhood Asthma
Asthma is a major cause of illness and health care costs: in 2016, almost 200,000 Americans were admitted to the hospital for an asthma attack, and 40% of them were children (https://www.cdc.gov/asthma/healthcare-use/healthcare-use-2016.htm). It therefore makes sense to consider asthma prevention
Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients
Objectives Tricuspid valve disease is increasingly encountered, but surgery is rarely performed in isolation, in part because of a reported higher operative risk than other single-valve operations. Although guidelines recommend valve repair, there is sparse literature for the optimal surgical
Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia
Heterozygous familial hypercholesterolemia, a genetic disorder that affects 1 in 250 persons or 30 million people worldwide, is characterized by elevated levels of low-density lipoprotein (LDL) cholesterol from birth. Without treatment, the condition is associated with premature complications and…
Am I Part of the Cure or Am I Part of the Disease? Keeping Coronavirus Out When a Doctor Comes Home
Last year, after a month of dry cough and shortness of breath while walking up the steep steps of Fillmore Street in San Francisco, Mary, my mother-in-law and housemate, noticed that she was becoming more and more easily winded. When
Enterococcus in Graft-versus-Host Disease
Allogeneic hematopoietic-cell transplantation is a mainstay of treatment for hematologic cancers, and the gut microbiota — the collection of archaea, bacteria, fungi, protists, and viruses that reside in the gastrointestinal tract — are emerging as a pivotal influence on its
LRR-ning the Rules: Synapse Organization in the Primary Rod Pathway
In this issue of Neuron, Sinha et al. (2020) demonstrate that synaptic organization at rod bipolar cell terminals is regulated by a leucine-rich repeat protein, LRRTM4. LRRTM4 is expressed specifically by rod bipolar cells; eliminating it in mouse retina perturbs the
[Editorial] A radical proposal for the EU budget: brain health
Every day, the European Parliament in Brussels, Belgium, bustles with the activity of meetings held by lobbyists trying to influence decision-making. But now that the European Union (EU) is negotiating the Multiannual Financial Framework for the 2021–27 budget, the frenzy
Covid-19: how doctors and healthcare systems are tackling coronavirus worldwide
United StatesThe United States declared a national emergency on 13 March as covid-19 spread to 49 of the country’s 50 states.President Donald Trump announced $50bn (£42.1bn; €45.6bn) to help combat…
Publisher Correction: Lineage plasticity in cancer: a shared pathway of therapeutic resistance
Nature Reviews Clinical Oncology, Published online: 17 March 2020; doi:10.1038/s41571-020-0355-5 Publisher Correction: Lineage plasticity in cancer: a shared pathway of therapeutic resistance
Enterococcus in Graft-versus-Host Disease
Allogeneic hematopoietic-cell transplantation is a mainstay of treatment for hematologic cancers, and the gut microbiota — the collection of archaea, bacteria, fungi, protists, and viruses that reside in the gastrointestinal tract — are emerging as a pivotal influence on its
Additional Considerations Regarding Point-of-care HIV Viral Load in Pregnant Women Without Prenatal Care
Worry and FRET: ROS Production Leads to Fluorochrome Tandem Degradation and impairs Interpretation of Flow Cytometric Results
It is hard to overstate the importance of flow cytometry for immunology research. As the field has advanced, the need for an array of fluorophores to meet different excitation and emission characteristics has increased. A predominant method of extending the
Against Medical Advice
Before she arrived, it was as if she had already left. Her chart was riddled with indicators. This past February, when she had her first stroke, she had left the hospital against medical advice. Two months later, when she had
[Editorial] NCD threat: falling on deaf ears
Non-communicable diseases (NCDs) such as stroke, heart disease, diabetes, chronic lung diseases, and cancer constitute the leading cause of mortality and disability globally. NCDs also cause poverty, lead to inequalities between countries and populations, and are a major threat to
Osteitis Fibrosa Cystica
Figure 1.
Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1
To the Editor: A novel human coronavirus that is now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (formerly called HCoV-19) emerged in Wuhan, China, in late 2019 and is now causing a pandemic. We analyzed the aerosol and surface
[Editorial] Rare diseases: clinical progress but societal stalemate
On Feb 18, 2020, Quaden Bayles’ mother broadcasted a heart-breaking video live on Facebook, in which the 9-year-old boy cried and said he wanted to end his life because of the relentless bullying about his health condition. Quaden has achondroplasia,
Guided Self-help Program May Help Refugees in Distress
A guided self-help program that uses audio courses and an illustrated book helped reduce psychological distress and improve functioning among female South Sudanese refugees in Uganda, according to the results of a cluster randomized trial.
The EVALI and Youth Vaping Epidemics — Implications for Public Health
Since entering the U.S. marketplace in 2007, e-cigarette, or vaping, products have evolved into a diverse class of inhaled aerosol devices. Earlier generations of these products were disposable, resembled conventional cigarettes in shape, and were designed to deliver nicotine to
Covid-19: Trump sought to buy vaccine developer exclusively for US, say German officials
The US president, Donald Trump, made secret overtures to the German company CureVac—one of the leading contenders to create a covid-19 vaccine—in the hope of luring it to the United States, say…
Highlights from this issue
‘No man is an island entire of itself…’.1 We can be certain that John Donne was not thinking about the inter-relationships between medical specialties when he wrote those lines in 1642 but such is the resonance of the ideas that
Intestinal microbiota predict HSCT outcome
Nature Reviews Clinical Oncology, Published online: 16 March 2020; doi:10.1038/s41571-020-0351-9 Intestinal microbiota predict HSCT outcome
Context-Dependent Immune Responses Explain Pancreatic Cancer Immunoresistance
Immunotherapy is standard of care for many malignancies, including non-small cell lung cancer, but its benefits have not extended to pancreatic cancer. In this issue of Cancer Cell, DeNardo and colleagues investigate the differences in immune response in lung and
Using antagonistic pleiotropy to design a chemotherapy-induced evolutionary trap to target drug resistance in cancer
Nature Genetics, Published online: 16 March 2020; doi:10.1038/s41588-020-0590-9 CRISPR–Cas9 knockout screens in chemotherapy-treated acute myeloid leukemia cells help map the drug-dependent genetic basis of fitness trade-offs (antagonistic pleiotropy) for the design of evolutionary traps that target drug resistance in cancer.
History in a Crisis — Lessons for Covid-19
Writing in the heady days of new antibiotics and immunizations, esteemed microbiologists Macfarlane Burnet and David White predicted in 1972 that “the most likely forecast about the future of infectious diseases is that it will be very dull.” They acknowledged
Covid-19: junior doctor calls on colleagues to gather supplies for staff working long hours
A junior doctor has called on her colleagues to gather supplies that will help healthcare professionals working long hours during the covid-19 outbreak.Josie Cheetham, chair of the BMA’s Junior…
Lithium: a slow burner
It took Mogens Schou and his collaborators two decades to get lithium accepted for the prevention of mania. Along the way he was vilified and his scientific objectivity questioned. These regrettable delays led to many unnecessary suicides. More profitable rebranded
Cardiovascular magnetic resonance T2* mapping for the assessment of cardiovascular events in hypertrophic cardiomyopathy
Background Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of adverse cardiac events. Beyond classic risk factors, relative myocardial ischaemia and succeeding myocardial alterations, which can be detected using either contrast agents or parametric mapping in cardiovascular magnetic resonance
Erratum: Mesothelioma: Scientific clues for prevention, diagnosis, and therapy
Six-Year Follow-up of a Trial of Antenatal Vitamin D for Asthma Reduction
Vitamin D deficiency has been hypothesized to have contributed to the increase in asthma and allergies in westernized societies. Because asthma and wheezing illnesses begin very early in life, studies of prenatal and early-life risk factors are crucial. Observational studies
When Sensitivity Is a Liability
You find a spot in the shadows of the emergency department. A nurse has turned off a bank of overhead lamps, creating a twilight that’s anything but peaceful. You fidget with the stethoscope pocketed in the white coat you never
Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality
Worldwide, more than 500,000 cases of incident hepatocellular carcinoma are diagnosed each year, related primarily to chronic infection with hepatitis B or hepatitis C virus. Since the 1990s, the incidences of cirrhosis and hepatocellular carcinoma have increased dramatically in the
Reply to the Editor of the American Journal of Obstetrics and Gynecology: Other Causes of Fetal Brain Injury
Sir Frank Macfarlane BurnetMark Nicholls focuses on the work of Frank Macfarlane Burnet, who shared the Nobel Prize in Physiology or Medicine 1960 with Peter Medawar ‘for discovery of acquired immunological tolerance’
Case 8-2020: An 89-Year-Old Man with Recurrent Abdominal Pain and Bloody Stools
Presentation of Case. Dr. Emily W. Lopes: An 89-year-old man was evaluated at this hospital because of recurrent bloody stools. Two years before the current evaluation, the patient underwent repair of a right inguinal hernia. After he recovered from that
Interchangeable Insulins — New Pathways for Safe, Effective, Affordable Diabetes Therapy
Human insulin was the first major product of the modern biotech industry and has been available in the U.S. market since 1982. Yet as insulin patents have expired in the early 21st century, the prices of human insulins have been
Audio Interview: Making Decisions about Covid-19 Testing and Treatment for Your Patients
The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission,
Case 8-2020: An 89-Year-Old Man with Recurrent Abdominal Pain and Bloody Stools
Presentation of Case. Dr. Emily W. Lopes: An 89-year-old man was evaluated at this hospital because of recurrent bloody stools. Two years before the current evaluation, the patient underwent repair of a right inguinal hernia. After he recovered from that
Cost and Reimbursement of Providing Routine Vaccines in Outpatient Obstetrician/Gynecologist Settings
Providing routine vaccines to patients in outpatient ob/gyn settings appears to be cost neutral in general, and cost beneficial for practices for some patient populations.
Case 8-2020: An 89-Year-Old Man with Recurrent Abdominal Pain and Bloody Stools
Presentation of Case. Dr. Emily W. Lopes: An 89-year-old man was evaluated at this hospital because of recurrent bloody stools. Two years before the current evaluation, the patient underwent repair of a right inguinal hernia. After he recovered from that
History in a Crisis — Lessons for Covid-19
Writing in the heady days of new antibiotics and immunizations, esteemed microbiologists Macfarlane Burnet and David White predicted in 1972 that “the most likely forecast about the future of infectious diseases is that it will be very dull.” They acknowledged
A Locally Transmitted Case of SARS-CoV-2 Infection in Taiwan
To the Editor: Since December 2019, an outbreak of infection with the novel coronavirus (SARS-CoV-2) has developed in Wuhan, China, and has spread to several countries, typically by travelers returning from China. Of the 3 million Taiwanese persons who work
Against Medical Advice
Before she arrived, it was as if she had already left. Her chart was riddled with indicators. This past February, when she had her first stroke, she had left the hospital against medical advice. Two months later, when she had
Detection of Covid-19 in Children in Early January 2020 in Wuhan, China
To the Editor: A small number of cases of coronavirus disease 2019 (Covid-19) have been described in children, and our understanding of the spectrum of illness is limited. We conducted a retrospective analysis involving hospitalized children in Wuhan, China. From
[Editorial] Climate migration requires a global response
As a real, tangible anthropogenic climate crisis starts to alter centuries of patterns of human behaviour, migration is beginning to take on a different shape. Extreme weather events are becoming more common, contributing to pre-existing drivers of migration, and as
Covid-19: UK holds off closing schools and restricts testing to people in hospital
People displaying covid-19 symptoms—a new, continuous cough or a high temperature—should self-isolate at home for at least seven days, no matter how mild their symptoms are, the UK prime minister has…
Heartbeat: focus on heart disease in women
The relationship between hormone status and cardiovascular disease (CVD) in women remains controversial. CVD mortality is higher in women who experience period cessation at a younger age but few studies have examined the effect of menopause on risk factors for
Lung cancer mortality among construction workers: implications for early detection
Objectives This study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening. Methods Predictive models were based
Enterococcus in Graft-versus-Host Disease
Allogeneic hematopoietic-cell transplantation is a mainstay of treatment for hematologic cancers, and the gut microbiota — the collection of archaea, bacteria, fungi, protists, and viruses that reside in the gastrointestinal tract — are emerging as a pivotal influence on its
Complications of Unsafe and Self-Managed Abortion
When abortion is legally restricted or otherwise inaccessible, girls, women, and those who care about them look outside formal medical care to end pregnancies. Worldwide, people increasingly choose misoprostol or a combination of mifepristone and misoprostol to end pregnancies on
The role of aspirin in prevention of preeclampsia in twin pregnancies: Does the dose matter?
The aspirin use in twin pregnancies for prevention of preeclampsia is a controversial topic and the evidence on the required dose of aspirin is scarce. We aimed to assess the efficacy of 75mg/day versus 150mg/day aspirin for prevention of preeclampsia
Vitamin D Supplementation during Pregnancy and the Prevention of Childhood Asthma
Asthma is a major cause of illness and health care costs: in 2016, almost 200,000 Americans were admitted to the hospital for an asthma attack, and 40% of them were children (https://www.cdc.gov/asthma/healthcare-use/healthcare-use-2016.htm). It therefore makes sense to consider asthma prevention
Transcatheter aortic valve replacement in patients with severe aortic stenosis and active cancer: a systematic review and meta-analysis
Background Patients with severe aortic stenosis and concomitant active cancer (AC) are considered high-risk patients and usually are not allowed to undergo surgical valve replacement. Transcatheter aortic valve replacement (TAVR) may be an attractive option for them; however, little is
Against Medical Advice
Before she arrived, it was as if she had already left. Her chart was riddled with indicators. This past February, when she had her first stroke, she had left the hospital against medical advice. Two months later, when she had
Osteitis Fibrosa Cystica
Figure 1.
Enterococcus in Graft-versus-Host Disease
Allogeneic hematopoietic-cell transplantation is a mainstay of treatment for hematologic cancers, and the gut microbiota — the collection of archaea, bacteria, fungi, protists, and viruses that reside in the gastrointestinal tract — are emerging as a pivotal influence on its
Osteitis Fibrosa Cystica
Figure 1.
The EVALI and Youth Vaping Epidemics — Implications for Public Health
Since entering the U.S. marketplace in 2007, e-cigarette, or vaping, products have evolved into a diverse class of inhaled aerosol devices. Earlier generations of these products were disposable, resembled conventional cigarettes in shape, and were designed to deliver nicotine to
Conservative Oxygen Therapy during Mechanical Ventilation in the ICU
The provision of supplemental oxygen to patients in the intensive care unit (ICU) who require invasive mechanical ventilation often exposes them to a high fraction of inspired oxygen (Fio2) and a higher-than-normal partial pressure of arterial oxygen (Pao2). Among adults
Cognitive load theory and differential attainment
Linton discusses a multi-pronged approach to tackling differential attainment.1 Another approach, not considered by Linton or the General Medical Council in its report published last year,2 is using…
Restless legs syndrome following the use of ziprasidone: a case report
Restless legs syndrome (RLS) is a common sleep-related movement disorder characterised by an uncomfortable urge to move the legs that occurs during periods of inactivity. Although there have been many case reports on antipsychotic-induced RLS, ziprasidone has never been reported
[Editorial] Cultivating conditions for artificial intelligence to flourish
Research into medical applications of artificial intelligence (AI) is progressing at an astonishing pace, and the field of gastroenterology is no exception. A search of the ClinicalTrials.gov database yields an array of ongoing AI-based studies in Crohn’s disease, bowel preparation,
Data Citizenship under the 21st Century Cures Act
Under the U.S. Health Information Technology for Economic and Clinical Health (HITECH) Act, $48 billion in federal funds were invested to promote adoption of electronic health records (EHRs). Now, in an effort to realize returns on this outlay — and
Lower Blood Pressure in South Asia? Trial Evidence
The report by Jafar et al. in this issue of the Journal suggests that a low-cost intervention, if scaled up, “might translate into substantial reductions in premature deaths and disability.” This potential benefit arises from the reduction in systolic blood
FAIR SCI Ahead: The Evolution of the Open Data Commons for Pre-Clinical Spinal Cord Injury Research
Journal of Neurotrauma, Volume 37, Issue 6, Page 831-838, March 15, 2020.
Covid-19: UK budget gives {pound}94 a week statutory sick pay to self-isolators and their carers
As part of its 2020 budget the UK government will extend statutory sick pay of £94.25 (€108; $121) a week to include people advised to self-isolate because of covid-19 and to those caring for…
Erratum: Mesothelioma: Scientific clues for prevention, diagnosis, and therapy
Repressors of healthy ageing
Nature Reviews Genetics, Published online: 10 March 2020; doi:10.1038/s41576-020-0226-z RNA interference screening in Caenorhabditis elegans has identified two repressive epigenetic regulators of age-related behavioural performance that are conserved in mammals.
Audio Interview: What Clinicians Need to Know in Diagnosing and Treating Covid-19
The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission,
US Zika-Related Birth Defects in High-Transmission Areas
In US regions with widespread Zika virus transmission, birth defects that possibly were virus-related increased about 4-fold, from 1.3 per 1000 live births between January and March 2016 to 5.6 per 1000 live births in January to March 2017, according
When Sensitivity Is a Liability
You find a spot in the shadows of the emergency department. A nurse has turned off a bank of overhead lamps, creating a twilight that’s anything but peaceful. You fidget with the stethoscope pocketed in the white coat you never
Covid-19: What’s the current advice for UK doctors?
I haven’t been fit tested for the correct masks (FFP3)? Can I be asked to go into a room with a patient with suspected or confirmed covid-19?UK employers have a legal obligation under the Health and…
Lineage plasticity in cancer: a shared pathway of therapeutic resistance
Nature Reviews Clinical Oncology, Published online: 09 March 2020; doi:10.1038/s41571-020-0340-z Lineage plasticity is a source of intratumoural heterogeneity and enables tumour adaptation to an adverse tumour microenvironment, eventually leading to therapeutic resistance. The authors of this Review provide an overview
Erratum: Mesothelioma: Scientific clues for prevention, diagnosis, and therapy
Accurate Diagnosis of Endometriosis Using Serum MicroRNAs
Endometriosis, a chronic disease that afflicts millions of women worldwide, has traditionally been diagnosed by laparoscopic surgery. This diagnostic barrier delays identification and treatment by years, resulting in prolonged pain and disease progression. Development of a non-invasive diagnostic test could
Effects of spirulina on weight loss and blood lipids: a review
Spirulina, a cyanobacteria commonly referred to as a blue-green algae, is one of the oldest lifeforms on Earth. Spirulina grows in both fresh and saltwater sources and is known for its high protein and micronutrient content. This review paper will
First Case of 2019 Novel Coronavirus in the United States
On December 31, 2019, China reported a cluster of cases of pneumonia in people associated with the Huanan Seafood Wholesale Market in Wuhan, Hubei Province. On January 7, 2020, Chinese health authorities confirmed that this cluster was associated with a
Hospital trust at centre of inquiry into babies’ deaths to repay {pound}1m it received for “good care”
A hospital trust at the centre of an investigation into avoidable deaths of babies is to repay a reward of nearly £1m it received for providing good maternity care.Shrewsbury and Telford Hospital NHS…
Chemotherapy plus bevacizumab as an optimal first-line therapeutic treatment for patients with right-sided metastatic colon cancer: a meta-analysis of first-line clinical trials
Background Monoclonal antibodies of anti-epidermal growth factor receptor (EGFR) have been recommended as first-line therapy for patients with left-sided metastatic colorectal cancer (mCRC) with wild-type RAS. The effect of tumour laterality on antivascular endothelial growth factor antibody and how to
Erratum: Mesothelioma: Scientific clues for prevention, diagnosis, and therapy
Erratum: Mesothelioma: Scientific clues for prevention, diagnosis, and therapy
Polycystic ovary syndrome and lung function: a Mendelian randomization study
Six-Year Follow-up of a Trial of Antenatal Vitamin D for Asthma Reduction
Vitamin D deficiency has been hypothesized to have contributed to the increase in asthma and allergies in westernized societies. Because asthma and wheezing illnesses begin very early in life, studies of prenatal and early-life risk factors are crucial. Observational studies
Controlling the adaption behaviour of next-generation tissue-engineered cardiovascular implants via computational modellingWill computational modelling help to expedite clinical translation of next-generation bioengineered implants?
Erratum: Mesothelioma: Scientific clues for prevention, diagnosis, and therapy
Association between dysmenorrhea and chronic pain: A systematic review and meta-analysis of population-based studies
To synthesize the epidemiological findings for the associations between dysmenorrhea, including primary dysmenorrhea and endometriosis-associated dysmenorrhea, and any chronic pain conditions, including chronic pelvic pain, and chronic non-pelvic pain.
Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany
To the Editor: The novel coronavirus (2019-nCoV) from Wuhan is currently causing concern in the medical community as the virus is spreading around the world. Since identification of the virus in late December 2019, the number of cases from China
A Community-Based Intervention for Managing Hypertension in Rural South Asia
Uncontrolled high blood pressure is the leading attributable risk factor for death globally. Treatment of hypertension reduces risk, but less than one third of persons with hypertension have controlled blood pressure. Asians have enhanced susceptibility to vascular disease. Uncontrolled blood…
[Editorial] COVID-19: too little, too late?
Although WHO has yet to call the outbreak of SARS-CoV-2 infection a pandemic, it has confirmed that the virus is likely to spread to most, if not all, countries. Regardless of terminology, this latest coronavirus epidemic is now seeing larger
First Case of 2019 Novel Coronavirus in the United States
On December 31, 2019, China reported a cluster of cases of pneumonia in people associated with the Huanan Seafood Wholesale Market in Wuhan, Hubei Province. On January 7, 2020, Chinese health authorities confirmed that this cluster was associated with a
Nasal Deformity in Granulomatosis with Polyangiitis
Figure 1.
Are we ready for targeted therapy combinations in HCC?
Treatment options for advanced hepatocellular carcinoma (HCC) are limited. Although some multikinase inhibitors such as sorafenib show some benefit, this does not significantly alter the course of disease for most patients. Currently, several multikinase inhibitors were shown to work in
Sustainable conferences: encouraging people to think and act differently
It is time for us rethink the purpose and effectiveness of educational health events as well as consider reducing the associated high carbon footprint.1In 2009 I hosted a workshop for the European…
A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations
The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide and then onto half a dozen other countries between December 2019 and early 2020. The implementation of unprecedented strict quarantine measures in China has kept a large number
A Specialized Few Among Many: Identification of a Novel Lung Epithelial Stem Cell Population
The landscape of lung epithelial stem cells is getting more nuanced. In this issue of Cell Stem Cell, Kathiriya et al. (2020) describe a novel distal airway epithelial cell population with high regenerative potential.
MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis
The aggressiveness of prostate cancers ranges from indolent to highly lethal. Low-grade prostate cancer (i.e. grade group 1) has been shown in large trials to be associated with a very low risk of cancer-specific death. In contrast, cancers of grade
Colorectal cancer statistics, 2020
Abstract Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC occurrence based on incidence data (available through 2016) from population‐based cancer registries
Development and validation of a multivariable prediction model of spontaneous preterm delivery and microbial invasion of the amniotic cavity in women with preterm labor
Early spontaneous preterm delivery is often associated with microbial invasion of the amniotic cavity and/or intra-amniotic inflammation.
Lysine 4 of histone H3.3 is required for embryonic stem cell differentiation, histone enrichment at regulatory regions and transcription accuracy
Nature Genetics, Published online: 05 March 2020; doi:10.1038/s41588-020-0586-5 Replacement of lysine 4 or 36 with alanine in histone H3.3 impairs ESC differentiation and induces widespread gene expression changes. Expression of H3.3K4A, but not H3.3K36A, leads to H3.3 depletion, reduces remodeler
Association of left anterior descending artery involvement on clinical outcomes among patients with STEMI presenting with and without out-of-hospital cardiac arrest
Background ST-segment elevation myocardial infarction (STEMI) outcomes are influenced by the location of the culprit vessel with worse outcomes portended with a left anterior descending (LAD) culprit lesion. However, relatively little is known about the independent association of LAD involvement
Under Our Very Eyes
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors’ commentary follows.
Hepatopulmonary Syndrome
Figure 1.
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