The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

An overview of the self-organizing map algorithm, on which the papers in this issue are based, is presented in this article.

The Self-Organizing Map

In this paper we develop new Newton and conjugate gradient algorithms on the Grassmann and Stiefel manifolds. These manifolds represent the constraints that arise in such areas as the symmetric eigenvalue problem, nonlinear eigenvalue problems, electronic structures computations, and signal processing. In addition to the new algorithms, we show how the geometrical framework gives penetrating new insights allowing us to create, understand, and compare algorithms. The theory proposed here provides a taxonomy for numerical linear algebra algorithms that provide a top level mathematical view of previously unrelated algorithms. It is our hope that developers of new algorithms and perturbation theories will benefit from the theory, methods, and examples in this paper.

http://www-math.mit.edu/~edelman/publications/geometry_of_algorithms.pdf

The Geometry of Algorithms with Orthogonality Constraints

结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Type 2 diabetes mellitus (T2DM) is an expanding global health problem, closely linked to the epidemic of obesity. Individuals with T2DM are at high risk for both microvascular complications (including retinopathy, nephropathy and neuropathy) and macrovascular complications (such as cardiovascular comorbidities), owing to hyperglycaemia and individual components of the insulin resistance (metabolic) syndrome. Environmental factors (for example, obesity, an unhealthy diet and physical inactivity) and genetic factors contribute to the multiple pathophysiological disturbances that are responsible for impaired glucose homeostasis in T2DM. Insulin resistance and impaired insulin secretion remain the core defects in T2DM, but at least six other pathophysiological abnormalities contribute to the dysregulation of glucose metabolism. The multiple pathogenetic disturbances present in T2DM dictate that multiple antidiabetic agents, used in combination, will be required to maintain normoglycaemia. The treatment must not only be effective and safe but also improve the quality of life. Several novel medications are in development, but the greatest need is for agents that enhance insulin sensitivity, halt the progressive pancreatic β-cell failure that is characteristic of T2DM and prevent or reverse the microvascular complications. For an illustrated summary of this Primer, visit: http://go.nature.com/V2eGfN.

Type 2 diabetes mellitus.

Sleep studies require the use of several channels of EEG. The analysis of vector EEG, exhibits significant advantages over scalar analysis. Novel algorithms for segmentation, classification and compression of vector EEG are described. The statistics of the suggested measures for segmentation and classification are discussed. The algorithms were evaluated on four patients, yielding mean correct sleep staging of about 85%.

EEG Sleep Staging Using Vectorial Autoregressive Models

Two major problems of student laboratory courses are analyzed and discussed: (1) the qualifications and motivations of typical laboratory instructors, and (2) the attitude at the departmental policy-making level towards the laboratory. The paper concentrates mainly on the presentation of problems, but also suggests some short-term solutions.

Manpower for Engineering Laboratory Courses

The term ‘epidemiology’ originates from the Greek language and literally means ‘the study of what is upon the people’. There are many more modern definitions of epidemiology such as ‘the study of the distribution and determinants of disease frequency in human populations’. The relationship between epidemiology and public health is close. Epidemiology focuses on the pathogenesis of the disease, i.e. determinants. Public health primarily aims at prevention, evaluation of care and medical decisionmaking. Epidemiology is frequently described as the ‘basic science of public health’ and is, in conjunction with health economics and social sciences, the methodological backbone for public health. The exciting aspect of epidemiology is that it is often exploratory and hypothesis generating. However, for observational research to become ‘real’, the findings need to be replicated in other populations, further explained by laboratory research and evaluated by clinical research. Although the realm is very broad-ranging, from understanding pathogenesis to informing disease control and prevention, at the BJD we are very interested in clinical epidemiological studies that have the patients’ benefit in mind (Fig. 1).

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/bjd.14100

Dermatoepidemiology; what's up people?

Trichodiscomas are hamartomas of the hair disk and appear as multiple, firm, well-circumscribed papules measuring a few millimeters. In most cases, trichodiscomas are distributed on the face and neck. Trichodiscomas may occur as isolated tumors or in association with other follicular tumors. In some cases, multiple trichodiscomas appear in association with fibrofolliculomas or acrochordons. We herein describe multiple agminated trichodiscomas in the earlobe.

Multiple agminated trichodiscomas in the earlobe

Abstract The timing pattern in which dipeptidyl-peptidase IV inhibitors (DPP4i) confer the risk of bullous pemphigoid (BP) is unknown. To investigate the odds of BP following exposure to DPP4i and to perform a duration-response analysis evaluating the risk of BP in relation to the duration of exposure to the culprit drug. A population-based nested case–control study was performed comparing diabetic patients with BP ( n = 1458) with age-, sex- and ethnicity-matched diabetic control subjects ( n = 6051) with respect to the prevalence of exposure to DPP4i. Adjusted odds ratios (ORs) were estimated by logistic regression. Overall exposure to DPP4i was associated with an 80% increase in the odds of subsequent BP (OR, 1.81; 95% CI, 1.46–2.08; P &lt; 0.001). In an intraclass analysis, the odds of BP were increased in association with vildagliptin (OR, 3.40; 95% CI, 2.69–4.29; P &lt; 0.001) and sitagliptin (OR, 1.56; 95% CI, 1.33–1.84; P &lt; 0.001). In a duration-response analysis, the highest likelihood of BP was found 1–2 years after commencing the drug (OR, 2.66; 95% CI, 1.97–3.59; P &lt; 0.001). The odds of BP were increased across all time periods and retained its statistical significance even ≥ 6 years after the drug initiation (OR, 1.44; 95% CI, 1.09–1.91; P = 0.011). Relative to other diabetic patients with BP, patients with DPP4i-associated BP were more likely to be admitted to inpatient dermatologic wards (OR, 1.66; 95% CI, 1.30–2.13; P &lt; 0.001) and had higher mean(SD) numbers of outpatient dermatologist visits (14.7[14.8] vs. 12.3[13.2], respectively; P = 0.006). DPP4i should be suspected as a predisposing factor for BP even numerous years after the drug initiation. 

/pdf/dipeptidyl-peptidase-iv-inhibitor-dpp4i-confers-increased-178sx7dx.pdf

Arnon D. Cohen

Papers

EEG Sleep Staging Using Vectorial Autoregressive Models

Manpower for Engineering Laboratory Courses

Dermatoepidemiology; what's up people?

Multiple agminated trichodiscomas in the earlobe

Dipeptidyl-peptidase IV inhibitor (DPP4i) confers increased odds of bullous pemphigoid even years after drug initiation