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

The reference human genome sequence set the stage for studies of genetic variation and its association with human disease, but epigenomic studies lack a similar reference. To address this need, the NIH Roadmap Epigenomics Consortium generated the largest collection so far of human epigenomes for primary cells and tissues. Here we describe the integrative analysis of 111 reference human epigenomes generated as part of the programme, profiled for histone modification patterns, DNA accessibility, DNA methylation and RNA expression. We establish global maps of regulatory elements, define regulatory modules of coordinated activity, and their likely activators and repressors. We show that disease- and trait-associated genetic variants are enriched in tissue-specific epigenomic marks, revealing biologically relevant cell types for diverse human traits, and providing a resource for interpreting the molecular basis of human disease. Our results demonstrate the central role of epigenomic information for understanding gene regulation, cellular differentiation and human disease.

Integrative analysis of 111 reference human epigenomes

Background: Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acqui...

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.

正しい方法がわかる臨床基本手技 : from the New England journal of medicine

超出生体重児に対する早期デキサメサゾン投与の有用性 : National Institute of Child Health and Human Development Neonatal research Network報告 (海外誌掲載論文の和文概要とそれに対するコメント)

Life expectancy in most countries has been increasing continually over the several few decades thanks to significant improvements in medicine, public health, as well as personal and environmental hygiene. However, increased life expectancy combined with falling birth rates are expected to engender a large aging demographic in the near future that would impose significant burdens on the socio-economic structure of these countries. Therefore, it is essential to develop cost-effective, easy-to-use systems for the sake of elderly healthcare and well-being. Remote health monitoring, based on non-invasive and wearable sensors, actuators and modern communication and information technologies offers an efficient and cost-effective solution that allows the elderly to continue to live in their comfortable home environment instead of expensive healthcare facilities. These systems will also allow healthcare personnel to monitor important physiological signs of their patients in real time, assess health conditions and provide feedback from distant facilities. In this paper, we have presented and compared several low-cost and non-invasive health and activity monitoring systems that were reported in recent years. A survey on textile-based sensors that can potentially be used in wearable systems is also presented. Finally, compatibility of several communication technologies as well as future perspectives and research challenges in remote monitoring systems will be discussed.

Wearable Sensors for Remote Health Monitoring.

Advancements in medical science and technology, medicine and public health coupled with increased consciousness about nutrition and environmental and personal hygiene have paved the way for the dramatic increase in life expectancy globally in the past several decades. However, increased life expectancy has given rise to an increasing aging population, thus jeopardizing the socio-economic structure of many countries in terms of costs associated with elderly healthcare and wellbeing. In order to cope with the growing need for elderly healthcare services, it is essential to develop affordable, unobtrusive and easy-to-use healthcare solutions. Smart homes, which incorporate environmental and wearable medical sensors, actuators, and modern communication and information technologies, can enable continuous and remote monitoring of elderly health and wellbeing at a low cost. Smart homes may allow the elderly to stay in their comfortable home environments instead of expensive and limited healthcare facilities. Healthcare personnel can also keep track of the overall health condition of the elderly in real-time and provide feedback and support from distant facilities. In this paper, we have presented a comprehensive review on the state-of-the-art research and development in smart home based remote healthcare technologies.

Smart Homes for Elderly Healthcare—Recent Advances and Research Challenges

Ubiquitous vital signs sensing using wireless medical sensors are promising alternatives to conventional, in-hospital healthcare systems. In this work, a wearable ECG sensor is proposed. This sensor system combined an appropriate wireless protocol for data communication with capacitive ECG signal sensing and processing. The ANT protocol was used as a low-data-rate wireless module to reduce the power consumption and size of the sensor. Furthermore, capacitive ECG sensing is a simple technique that avoids direct contact with the skin and provides maximum convenience to the user. In our work, small capacitive electrodes were integrated into a cotton T-shirt together with a signal processing and transmitting board on a two-layer standard printed circuit board design technology. The entire system has small size, is thin, and has low power consumption compared to recent ECG monitoring systems. In addition, appropriate signal conditioning and processing were implemented to remove motion artifacts. The acquired ECG signals are comparable to ones obtained using conventional glued-on electrodes, and are easily read and interpreted by a cardiologist.

A wireless wearable ECG sensor for long-term applications

The sinoatrial node is the primary pacemaker of the heart. Nodal dysfunction with aging, heart failure, atrial fibrillation, and even endurance athletic training can lead to a wide variety of pathological clinical syndromes. Recent work utilizing molecular markers to map the extent of the node, along with the delineation of a novel paranodal area intermediate in characteristics between the node and the surrounding atrial muscle, has shown that pacemaker tissue is more widely spread in the right atrium than previously appreciated. This can explain the phenomenon of a "wandering pacemaker" and concomitant changes in the P-wave morphology. Extensive knowledge now exists regarding the molecular architecture of the node (in particular, the expression of ion channels) and how this relates to pacemaking. This review is an up-to-date summary of the current state of our appreciation of the above topics.

http://www.cardresp.fmed.edu.uy/Boyett_2010_review.pdf

The Anatomy and Physiology of the Sinoatrial Node—A Contemporary Review

Background The healthcare burden related to congenital heart disease (CHD) is increasing with improving survival We assessed changing trends in prenatal risk factors for CHD in the current era in a Canadian cohort

Methods and Results CHD patients <18 years old (n=2339) and controls without structural heart disease (n=199) were prospectively enrolled in an Ontario province-wide biobank registry from 2008–2011 Family history, frequency of extra-cardiac anomalies (ECAs), and antenatal risk factors were assessed Temporal trends were analyzed and associations with CHD were measured using linear and logistic regression Family history of CHD and frequency of major ECAs was higher in cases versus controls ( P <0001) Despite an increase in genetic testing in the recent era, only 95% of cases with CHD had a confirmed genetic diagnosis Yield of genetic testing (ie, frequency of abnormal results) was higher in familial and syndromic cases There was an increase in parental age at conception, maternal prepregnancy body mass index, maternal urinary tract infections, type 1 diabetes, and exposure to nonfertility medications during pregnancy from 1990–2011 Later year of birth, family history of CHD, presence of major ECAs, maternal smoking during pregnancy, and maternal medication exposure were associated with increased odds of CHD ( P <005 for all) Advanced parental age was associated with increased odds of CHD caused by genetic abnormalities

Conclusions The increase in prenatal risk factors for CHD highlights the need for more rigorous ascertainment of genetic and environmental factors including gene-environment interactions that contribute to CHD

Tapas Mondal

Papers

Wearable Sensors for Remote Health Monitoring.

Smart Homes for Elderly Healthcare—Recent Advances and Research Challenges

A wireless wearable ECG sensor for long-term applications

The Anatomy and Physiology of the Sinoatrial Node—A Contemporary Review

Impact of Prenatal Risk Factors on Congenital Heart Disease in the Current Era