Transactions of the American Clinical and Climatological Association 

About: Transactions of the American Clinical and Climatological Association is an academic journal published by American Clinical And Climatological Association. The journal publishes majorly in the area(s): Health care & Medicine. It has an ISSN identifier of 0065-7778. Over the lifetime, 1356 publications have been published receiving 16624 citations.

Challenges and Opportunities Facing Medical Education

Abstract: Medical education is at a crossroads. Although unique features exist at the undergraduate, graduate, and continuing education levels, shared aspects of all three levels are especially revealing, and form the basis for informed decision-making about the future of medical education.This paper describes some of the internal and external challenges confronting undergraduate medical education. Key internal challenges include the focus on disease to the relative exclusion of behavior, inpatient versus outpatient education, and implications of a faculty whose research is highly focused at the molecular or submolecular level. External factors include the exponential growth in knowledge, associated technologic ("disruptive") innovations, and societal changes. Addressing these challenges requires decisive institutional leadership with an eye to 2020 and beyond--the period in which current matriculants will begin their careers. This paper presents a spiral-model format for a curriculum of medical education, based on disease mechanisms, that addresses many of these challenges and incorporates sound educational principles.

Cancer in the elderly.

Abstract: As the population expands, over the period from 2000 to 2050, the number and percentage of Americans over age 65 is expected to double. This population expansion will be accompanied by a marked increase in patients requiring care for disorders with high prevalence in the elderly. Since cancer incidence increases exponentially with advancing age, it is expected that there will be a surge in older cancer patients that will challenge both healthcare institutions and healthcare professionals. In anticipation of this challenge, researchers at the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio are conducting a series of investigations focused on the intersection of aging and cancer. Studies will be addressed in the high priority research areas of 1) Treatment Efficacy and Tolerance, 2) Effects of Comorbidities, 3) Psychosocial Issues, and 4) Biology of Aging Cancer.

Molecular pathogenesis of liver fibrosis.

Abstract: Hepatic fibrosis is the final common pathway for most chronic liver diseases. The cell responsible for hepatic fibrosis appears to be the activated myofibroblast. The myofibroblast may be derived from quiescent hepatic stellate cells, epithelial to mesenhymal transition, or derived from bone marrow precursors. Studies in primary cultures of myofibroblasts and in mouse models of hepatic fibrosis have revealed several common pathophysiological mechanisms. Hepatic fibrosis is strongly associated with oxidative stress, increased transforming growth factor beta, hepatocyte death, and chronic inflammation. Finally, the reversal of fibrosis depends upon the elimination of the activated myofibroblast.

Ageing and the Glomerular Filtration Rate: Truths and Consequences

Abstract: The process of glomerular filtration of plasma fluid has been known for over 160 years and the measurement of the rate of its formation (glomerular filtration rate, GFR) has been possible for over 80 years. Studies conducted in the 1930's to the 1950's clearly established that GFR declines, perhaps inexorably, with normal ageing, usually beginning after 30–40 years of age. The rate of decline may accelerate after age 50–60 years. This decline appears to be a part of the normal physiologic process of cellular and organ senescence and is associated with structural changes in the kidneys. In the last decade a new paradigm has been introduced in which the true or measured GFR is estimated (eGFR) by formulas based on serum creatinine levels and in which these estimates are applied to the diagnoses of chronic kidney disease (CKD) in the general population. These criteria for diagnosis of CKD include an absolute threshold for eGFR, unadjusted for the effects of age on the normal values for eGFR. A consequence of these criteria has been to overstate the frequency of CKD in the general population and to generate many “false positive” diagnoses of CKD. This paper discusses the known effects of ageing on GFR and the consequences of using a classification system for defining CKD that does not take into account the normal decline of GFR with ageing.

Placental-fetal glucose exchange and fetal glucose metabolism.

Abstract: Fetal glucose metabolism depends on additive effects of fetal plasma glucose and insulin. Glucose-stimulated insulin secretion increases over gestation, is down-regulated by constant hyperglycemia, but enhanced by pulsatile hyperglycemia. Insulin production is diminished in fetuses with intrauterine growth restriction (IUGR) by inhibition of pancreatic β-cell replication, but not by mechanisms that regulate insulin production or secretion, while the opposite occurs with hypoglycemia alone, despite its common occurrence in IUGR. Chronic hyperglycemia down-regulates glucose tolerance and insulin sensitivity with decreased expression of skeletal muscle and hepatic Glut 1 and 4 glucose transporters, while chronic hypoglycemia up-regulates these transporters. The opposite occurs for signal transduction proteins that regulate amino acid synthesis into protein. These results demonstrate the mixed phenotype of the IUGR fetus with enhanced glucose utilization capacity, but diminished protein synthesis and growth. Such adaptations might underlie childhood and adult metabolic disorders of insulin resistance, obesity, and diabetes mellitus.