Blockade to pathological #remodeling of #infarcted heart tissue using a porcupine antagonist

http://m.pnas.org/content/early/2017/01/30/1621346114

We demonstrate that WNT-974 can improve the recovery of heart function after left anterior descending coronary artery ligation by mitigating adverse remodeling of infarcted tissue. Injured heart tissue exposed to WNT-974 exhibits decreased scarring and reduced Col6 production. Our findings support the development of Porcn inhibitors as antifibrotic agents that could be exploited to promote heart repair following injury.

From Childhood to Adulthood: The Trajectory of #Damage in Patients with Childhood-Onset Systemic #Lupus Erythematosus

http://onlinelibrary.wiley.com/doi/10.1002/acr.23199/abstract

Patients with cSLE accrue damage steadily into adulthood. Baseline factors predict greater damage and/or influence the evolution of the damage trajectory. Additionally, SLE clinical features and therapies during the course of disease predict additional changes in the damage trajectory.

Perioperative timing of #infliximab and the risk of serious infection after elective hip and knee #arthroplasty

http://onlinelibrary.wiley.com/doi/10.1002/acr.23209/abstract

Administering infliximab within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short or long-term serious infection compared to withholding infliximab for longer time periods. Glucocorticoid use, especially > 10mg/day, was associated with an increased infection risk.

Population-Attributable Risk Proportion of Clinical #Risk Factors for #Breast Cancer

http://jamanetwork.com/journals/jamaoncology/article-abstract/2599991

Most women with breast cancer have at least 1 breast cancer risk factor routinely documented at the time of mammography, and more than half of premenopausal and postmenopausal breast cancers are explained by these factors. These easily assessed risk factors should be incorporated into risk prediction models to stratify breast cancer risk and promote risk-based screening and targeted prevention efforts.

The Pharmacodynamics, Pharmacokinetics, and Safety of #Arhalofenate in Combination with #Febuxostat When Treating Hyperuricemia Associated with Gout

http://www.jrheum.org/content/early/2016/12/08/jrheum.161062

ARH and FBX lowered SUA by complementary mechanisms. The combination provided greater decreases than each drug alone. The combination was well tolerated and appeared safe.

Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest #pain who can safely be removed from cardiac #monitoring

http://m.cmaj.ca/content/189/4/E139?ijkey=89cdc54f7aa0b4dd071990b90ae8e040971eb780&keytype2=tf_ipsecsha

We successfully validated the decision rule for safe removal of a large subset of patients with chest pain from cardiac monitoring after initial evaluation in the emergency department. Implementation of this simple yet highly sensitive rule will allow for improved use of health care resources.

Nicotine, #Carcinogen, and Toxin Exposure in Long-Term #E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study

http://annals.org/aim/article/2599869/nicotine-carcinogen-toxin-exposure-long-term-e-cigarette-nicotine-replacement

Former smokers with long-term e-cigarette–only or NRT-only use may obtain roughly similar levels of nicotine compared with smokers of combustible cigarettes only, but results varied. Long-term NRT-only and e-cigarette–only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes

Comparative Effectiveness of #Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With #Clostridium difficile Infection

http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2601079

Recurrence rates were similar among patients treated with vancomycin and metronidazole. However, the risk of 30-day mortality was significantly reduced among patients who received vancomycin. Our findings may further justify the use of vancomycin as initial therapy for severe CDI.

Physician burnout is a dysfunctional syndrome comprising emotional exhaustion, cynicism, depersonalization, and loss of empathy, accompanied by career dissatisfaction, from a feeling of meaninglessness of work and a sense of low personal esteem and accomplishment.2 Burnout represents a growing problem because it leads to serious harm to both physicians and patients. It produces physician impairment with poor judgment, treating patients as objects, medical errors, and poorer patient outcomes. Burned-out physicians exhibit work–life imbalance and conflicts, abandon the profession, elect premature retirement, and experience higher rates of depression, substance abuse, and suicide.

How can neurologists avoid burnout?

Longitudinal Associations Between Ambient Air #Pollution with #Insulin Sensitivity, β-Cell Function, and Adiposity in Los Angeles Latino Children

http://diabetes.diabetesjournals.org/content/early/2017/01/27/db16-1416

Higher NO2 and PM2.5 were associated with a faster decline in SI and a lower insulin sensitivity (SI) at age 18 independent of adiposity. NO2 exposure negatively affected β-cell function evidenced by a faster decline in disposition index (DI) and a lower DI at age 18. Higher NO2 and PM2.5 exposures over follow-up were also associated with a higher BMI at age 18. AAP exposure may contribute to development of type 2 diabetes through direct effects on insulin sensitivity and β-cell function.

Association of Coronary Artery #Calcium in Adults Aged 32 to 46 Years With Incident #Coronary Heart Disease and Death

http://jamanetwork.com/journals/jamacardiology/fullarticle/2601071

The presence of CAC among individuals aged between 32 and 46 years was associated with increased risk of fatal and nonfatal CHD during 12.5 years of follow-up. A CAC score of 100 or more was associated with early death. Adults younger than 50 years with any CAC, even with very low scores, identified on a computed tomographic scan are at elevated risk of clinical CHD, CVD, and death. Selective use of screening for CAC might be considered in individuals with risk factors in early adulthood to inform discussions about primary prevention.

Elevated Blood #Lead Levels Associated with Retained #Bullet Fragments

https://www.cdc.gov/mmwr/volumes/66/wr/mm6605a2.htm?s_cid=mm6605a2_w

Persons with elevated BLLs with unknown lead exposure source should be asked about RBFs. Furthermore, baseline and intermittent BLL tests should be considered in persons with a history of RBFs.

retained bullet fragments (RBFs)
blood lead level (BLL)

Risk of Acute #Kidney Injury After Intravenous #Contrast Media Administration

http://www.annemergmed.com/article/S0196-0644(16)31388-9/fulltext

In the largest well-controlled study of acute kidney injury following contrast administration in the ED to date, intravenous contrast was not associated with an increased frequency of acute kidney injury.

Exposure to low dose computed tomography for lung cancer #screening and risk of #cancer: secondary analysis of trial data and risk-benefit analysis

http://www.bmj.com/content/356/bmj.j347

Radiation exposure and cancer risk from low dose CT screening for lung cancer, even if non-negligible, can be considered acceptable in light of the substantial mortality reduction associated with screening.