The Type a Behavior Pattern and Acth Response to the Stress of Cardiac Catheterization.

There is substantial evidence to indicate that the Type A Behavior Pattern is associated with an increased risk of coronary heart disease. Recent research has shown that Type As, as compared to Type Bs, demonstrate enhanced biochemical and cardiovascular responses to stressful situations. These findings have led researchers to postulate that physiological reactivity may be one of the mechanisms through which Type A behavior confers coronary risk. The present study was designed to investigate physiological and psychological reactivity in Type A and Type B cardiac patients exposed to a cardiac catheterization. The effects of drugs (i.e., none versus beta-blockers and calcium channel blockers) on the response to stress was systematically evaluated. Dependent measures, adrenocorticotropic hormone (ACTH), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), state anxiety (STAI-state), and Total Mood Disturbance (TMD), were obtained prior to cardiac catheterization (day 1) and 24 hours later (day 2). A 2 x 2 x 2 (Behavior Type x Drug Group x Day) analysis of variance with repeated measures on day revealed significant main effects of day for ACTH, SBP, and state anxiety. A significant main effect for drug group and a significant Behavior Type x Drug interaction was revealed for ACTH. A significant Behavior Type x Day interaction was found for SBP. An additional analysis investigating the responses of extreme Type A and Type B subjects revealed significant main effects of day for HR and State Anxiety. The results of the present study failed to support previous research demonstrating that Type A subjects, as compared to Type B subjects, exhibit exaggerated responsivity to stress. Possible reasons for this failure to find significant A-B differences are explored. The major contribution of the present study was the finding, consistent with previous research, that the target medications were associated with substantially reduced responsivity to stress (as measured by ACTH) in Type A cardiac patients to levels consistent with the response of Type B cardiac patients. The clinical and research implications arising from this finding are discussed. Continued systematic evaluation of the effects of medications on reactivity is strongly recommended

Too Smart to Fail: Guide for the Struggling Medical Student

Medicine is a vocation of perpetual independent learning; long-term success is critically dependent on finding the right resources and establishing effective study methods and test-taking strategies. Students who struggle with the academic transition in medical school have common risk factors and characteristics. We highlight key resources that are available for struggling medical students with an emphasis on West Virginia\u27s HELP, ASPIRE, and STAT programs

Centronuclear myopathy in labrador retrievers: a recent founder mutation in the PTPLA gene has rapidly disseminated worldwide

Centronuclear myopathies (CNM) are inherited congenital disorders characterized by an excessive number of internalized nuclei. In humans, CNM results from ~70 mutations in three major genes from the myotubularin, dynamin and amphiphysin families. Analysis of animal models with altered expression of these genes revealed common defects in all forms of CNM, paving the way for unified pathogenic and therapeutic mechanisms. Despite these efforts, some CNM cases remain genetically unresolved. We previously identified an autosomal recessive form of CNM in French Labrador retrievers from an experimental pedigree, and showed that a loss-of-function mutation in the protein tyrosine phosphatase-like A (PTPLA) gene segregated with CNM. Around the world, client-owned Labrador retrievers with a similar clinical presentation and histopathological changes in muscle biopsies have been described. We hypothesized that these Labradors share the same PTPLA<sup>cnm</sup> mutation. Genotyping of an international panel of 7,426 Labradors led to the identification of PTPLA<sup>cnm</sup> carriers in 13 countries. Haplotype analysis demonstrated that the PTPLA<sup>cnm</sup> allele resulted from a single and recent mutational event that may have rapidly disseminated through the extensive use of popular sires. PTPLA-deficient Labradors will help define the integrated role of PTPLA in the existing CNM gene network. They will be valuable complementary large animal models to test innovative therapies in CNM

Gene dosage imbalances: action, reaction, and models.

International audienceSingle-gene deletions, duplications, and misregulation, as well as aneuploidy, can lead to stoichiometric imbalances within macromolecular complexes and cellular networks, causing their malfunction. Such alterations can be responsible for inherited or somatic genetic disorders including Mendelian diseases, aneuploid syndromes, and cancer. We review the effects of gene dosage alterations at the transcriptomic and proteomic levels, and the various responses of the cell to counteract their effects. Furthermore, we explore several biochemical models and ideas that can provide the rationale for treatments modulating the effects of gene dosage imbalances

Teaching the Art of Medicine: A Changing Portrait in Today's Medical Schools

Objective: The purpose of the present study was to assess attitudes toward the value of the “art of medicine� in medical education, beliefs regarding whether it can be taught and, if so, the methods of teaching that would be most effective. Method: As described by the British Medical Journal (2006), the “art of medicine� is defined in the present study as “the way in which knowledge is related to advice and treatment.1� Data was gathered via 278 anonymous surveys distributed to all Marshall-affiliated physicians, fellows, residents, and entering first-year medical students using a 5-point Likert Scale. Surveys were then analyzed by demographics including age, gender, medical school attended, and field of specialty. Results: Out of 278 surveys, 218 were returned resulting in a 78% response rate. Ninety percent of respondents believe that the art of medicine is as important to medical practice as the basic sciences and ninety-two percent believe it to be a critical component of medical education. Eighty-one percent believe that the art of medicine can be taught, and seventy-six percent would support finding more time in the curriculum for teaching the art of medicine. Out of options given, most respondents seemed to favor role-modeling by preceptors (68%), reviewing experiences of physicians (59%), and small-group discussions (56%) as the most effective methods of teaching the art of medicine. Discussion: The faculty, residents, and first-year students of Marshall University School of Medicine clearly support teaching the art of medicine and believe it can, in fact, be taught and is not just something inherent to certain individuals. Several methods of teaching were identified as important by those surveyed, and action must be taken to ensure the art of medicine is not lost in the shuffle or removed from the undergraduate medical curriculum.Marshall University School of Medicin

Teaching the Art of Medicine: A Changing Portrait in Today's Medical Schools

Objective: The purpose of the present study was to assess attitudes toward the value of the “art of medicine†in medical education beliefs regarding whether it can be taught and if so the methods of teaching that would be most effective. Method: As described by the British Medical Journal (2006) the “art of medicine†is defined in the present study as “the way in which knowledge is related to advice and treatment.1†Data was gathered via 278 anonymous surveys distributed to all Marshall-affiliated physicians fellows residents and entering first-year medical students using a 5-point Likert Scale. Surveys were then analyzed by demographics including age gender medical school attended and field of specialty. Results: Out of 278 surveys 218 were returned resulting in a 78% response rate. Ninety percent of respondents believe that the art of medicine is as important to medical practice as the basic sciences and ninety-two percent believe it to be a critical component of medical education. Eighty-one percent believe that the art of medicine can be taught and seventy-six percent would support finding more time in the curriculum for teaching the art of medicine. Out of options given most respondents seemed to favor role-modeling by preceptors (68%) reviewing experiences of physicians (59%) and small-group discussions (56%) as the most effective methods of teaching the art of medicine. Discussion: The faculty residents and first-year students of Marshall University School of Medicine clearly support teaching the art of medicine and believe it can in fact be taught and is not just something inherent to certain individuals. Several methods of teaching were identified as important by those surveyed and action must be taken to ensure the art of medicine is not lost in the shuffle or removed from the undergraduate medical curriculum

Characterization of deletions at 9p affecting the candidate regions for sex reversal and deletion 9p syndrome by MLPA

The distal region on the short arm of chromosome 9 is of special interest for scientists interested in sex development as well as in the clinical phenotype of patients with the 9p deletion syndrome, characterized by mental retardation, trigonocephaly and other dysmorphic features. Specific genes responsible for different aspects of the phenotype have not been identified. Distal 9p deletions have also been reported in patients with 46,XY sex reversal, with or without 9p deletion syndrome. Within this region the strongest candidates for the gonadal dysgenesis phenotype are the DMRT genes; however, the genetic mechanism is not clear yet. Multiple ligation-dependent probe amplification represents a useful technique to evaluate submicroscopic interstitial or distal deletions that would help the definition of the minimal sex reversal region on 9p and could lead to the identification of gene(s) responsible of the 46,XY gonadal disorders of sex development (DSD). We designed a synthetic probe set that targets genes within the 9p23-9p24.3 region and analyzed a group of XY patients with impaired gonadal development. We characterized a deletion distal to the DMRT genes in a patient with isolated 46,XY gonadal DSD and narrowed down the breakpoint in a patient with a 46,XY del(9)(p23) karyotype with gonadal DSD and mild symptoms of 9p deletion syndrome. The results are compared with other patients described in the literature, and new aspects of sex reversal and the 9p deletion syndrome candidate regions are discussed