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

Background 
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
Objectives 
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data Extraction 
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Results 
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
Conclusions 
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.

Please see later in the article for the Editors' Summary

/pdf/social-relationships-and-mortality-risk-a-meta-analytic-2ghmxi4ksm.pdf

Social Relationships and Mortality Risk: A Meta-analytic Review

Heavy metals are naturally occurring elements that have a high atomic weight and a density at least five times greater than that of water. Their multiple industrial, domestic, agricultural, medical, and technological applications have led to their wide distribution in the environment, raising concerns over their potential effects on human health and the environment. Their toxicity depends on several factors including the dose, route of exposure, and chemical species, as well as the age, gender, genetics, and nutritional status of exposed individuals. Because of their high degree of toxicity, arsenic, cadmium, chromium, lead, and mercury rank among the priority metals that are of public health significance. These metallic elements are considered systemic toxicants that are known to induce multiple organ damage, even at lower levels of exposure. They are also classified as human carcinogens (known or probable) according to the US Environmental Protection Agency and the International Agency for Research on Cancer. This review provides an analysis of their environmental occurrence, production and use, potential for human exposure, and molecular mechanisms of toxicity, genotoxicity, and carcinogenicity.

/pdf/heavy-metal-toxicity-and-the-environment-32mfkxp6nb.pdf

Heavy metal toxicity and the environment.

The detection of psychiatric illness by questionnaire

Epidemiology of insomnia: what we know and what we still need to learn

非鉛作業者スポット尿中の鉛,デルタ・アミノレブリン酸,およびコプロポルフィリンの濃度について

The fertility history of both women and men is associated with health and mortality in later life. The objective of this study was to analyze the associations between parity, social network, and perceived health measured using the Total Health Index (THI) consisting of 130 questions. The analytic sample included 4,858 women with a mean (SD) age of 54.4 (8.3) years who participated in the baseline study of the Komo-Ise cohort in 1993 and responded to the THI questionnaire. Data on parity were obtained from a follow-up study in 2000. THI scores differed across women with different parities. The mean (SD) of the integrated scale (T1) of THI calculated using a principal component analysis ranged between 0.3 (1.1) for nulliparous and -0.1 (1.0) for women of parity five or higher. A higher T1 reflected worse perceived health and predicted higher mortality in a previous study using the Komo-Ise cohort data. However, the association between parity and T1 became weaker and less consistent after adjusting for social network variables. The results suggest that the observed associations between parity and perceived health can be mediated by social support and networks. Causal relationships between parity, perceived health, and social networks need to be investigated in future research. 

Perceived health, fertility, and social network of middle-aged and older women in Japan

In the previous manuscript, authors reported that PSPS consisted mostly of proteins with small amounts of hexoses and riboses ; that revealed and ability to induce feeble Shwartzman reactions in rabbits and to produce the homocytotropic antibody in rats with relatively high titers. In this paper, PSPS had another aspect of biological activity as an inhibitory effect upon the TdR incorporation into human leucocytes stimulated with PPD, streptococcal M-protein and SK-SD, respectively.The results obtained were as follows :1) PSPS was able to stimulate the human leucocytes of healthy subjects in 2 out of 7 persons in whom stumulation index (S. I.) revealed 3 and 13, respectively.2) On the contrary, PSPS inhibited the TdR incorporation into leucocytes stimulated with PPD, streptococcal M-protein and SK-SD when that was given simultaneously with those antigens to a large extent of showing more than 70% of percentage inhibition in an individual case.3) Of particularly curious thing was that in a case (donor T. K.) in which the PSPS obviously stimulated the leucocytes with an increased TdR in corporation, inversely that inhibited TdR incorporation with approximate 70% of percentage inhibitions when was given simultaneously with specific antigens.4) There was a trend toward more increment of percentage inhibition in such a condition that the PSPS was given simultaneously or 2 hrs before the antigen stimulations with PPD, streptococcal M- protein and SK-SD in comparison with that 2hrs after antigen stimulations, suggesting a possible involvement of competitive binding between the receptors for antigens and for PSPS.5) Trypan blue exclusion test was carried out in order to exclude the cytotoxic activity of PSPS upon the leucocytes with the resultant data of over 80% viable cells remaining at 3, 4 and 5 day cultures.Thus, though PSPS was able to stimulate those leucocytes with the increased TdR incorporations in a part of healty subjects, that inversely inhibibited the TdR incorporations when was stimulated simulutaneously with the specific antigens. The mechanisms underlying these mutable contradictory actions of PSPS upon the human leucocytes should be more clarified on the basis of its chemical purification and mutual competitive inhibition of cell surface receptors involved in the regulation of DNA synthesis in nucleus.

https://www.jstage.jst.go.jp/article/kmj1951/26/2Supplement/26_2Supplement_135/_pdf

Inhibitory effect of phenol soluble proteinous substance (psps) derived from e coli upon the 3h-thymidine (tdr) incorporation into humanleucocytes stimulated with specific antigens such as ppd, streptococcal m- protein and sk-sd (varidase)

Subjective sleep ratings and polygraphic sleep parameters were recorded for 76 nights in 5 young and 3 old subjects in a noisy urban apartment (46.67 dB(A)) and in a quiet rural house (27.72 dB(A)), in order to clarify the difference between the sleep of the young and that of the old. The results were as follows. Both sleep period time (SPT) and total sleep time were longer for the young than for the old in a quiet bedroom. Both REM latency and sleep latency did not differ significantly between the young and the old. Mean sleep depth was shallow for the old because of more time for wake after sleep onset and stage 1 sleep and less time for slow wave sleep. There was no significant difference of stage 2 sleep between the young and old. The percent of REM in SPT were less for the old. The old subjects reported that they had less dreams than the young. The sleep of young was a little more susceptible to road traffic noise than that of old. In the elder subjects, "Couldn't sleep well" was found to be the most valid parameter of the quality of sleep, though "Difficult to fall asleep" was the most representative in the young.

https://www.jstage.jst.go.jp/article/jshhe1931/60/1/60_1_22/_pdf

Difference of Sleep EEG and Subjective Sleep Rating between Young and Old

The use of dietary supplements has become a common way to maintain good health. This study evaluated the status of supplement use and supplement user characteristics among participants from the Japan Nurses' Health Study, which comprised a cohort of Japanese female nursing professionals. A questionnaire survey covering the use of vitamins and supplements was conducted. Supplements were classified according to their constituents and formulations. Logistic regression analyses were performed to determine the characteristics of supplement users. Results were as follows. There were 4,017 supplement users (34.4% of 11,665 valid answers). The supplement types used were: vitamins (n=2,655), minerals (n=1,121), amino acids and proteins (n=139), botanical products (n=714), animal by-products (n=849), herbal medicines (n=152), nutritional drinks (n=19), others (n=117), and unclassified supplements (n=320). Logistic regression analyses showed that supplement use was significantly associated with age and body mass index, and there were significantly higher proportions of supplement users among pregnant women, black tea drinkers, soy milk consumers, and lactobacillus beverage drinkers. In conclusion, the overall percentage of supplement users was 34.4%. A high prevalence of supplement use was observed among older, non-obese, and pregnant participants, and those who paid more attention to their health. The prevalence of supplement users was significantly higher among those who habitually drank black tea, soy milk, and lactobacillus beverages, suggesting participants used supplements to maintain their health or prevent diseases based on high health consciousness.

Shosuke Suzuki

Papers

非鉛作業者スポット尿中の鉛,デルタ・アミノレブリン酸,およびコプロポルフィリンの濃度について

Perceived health, fertility, and social network of middle-aged and older women in Japan

Inhibitory effect of phenol soluble proteinous substance (psps) derived from e coli upon the 3h-thymidine (tdr) incorporation into humanleucocytes stimulated with specific antigens such as ppd, streptococcal m- protein and sk-sd (varidase)

Difference of Sleep EEG and Subjective Sleep Rating between Young and Old

Use of Dietary Supplements among Japanese Female Nursing Professionals.