Association of Adipose Tissue Distribution With Type 2 Diabetes in Breast Cancer Patients.

PURPOSE: We examined the association of adipose tissue distribution with type 2 diabetes (T2D) in breast cancer patients. METHODS: Participants (N = 238) diagnosed with breast cancer at 20-75 years old who received breast cancer treatment at a major hospital from January 1, 2012, to December 31, 2017, with at least one completed and identifiable abdominal or pelvic computed tomography (CT) scan and data regarding race and ethnicity were included. Thirty-two breast cancer patients were identified as T2D patients after their breast cancer diagnoses. The adipose tissue distribution (visceral fat area [VFA], subcutaneous fat area [SFA], and the ratio of VFA to SFA [VFA/SFA]) was quantified on CT images of the third lumbar vertebra. T2D status was retrieved from patients' electronic medical records. The association of adipose tissue distribution with T2D in women with breast cancer was examined using multivariable logistic regression. RESULTS: Participants with T2D had significantly smaller SFA compared to those without T2D (odds ratio [OR] = 0.88, 95% confidence interval [95% CI] = 0.81-0.96, per 10 cm2 SFA). A positive association of VFA/SFA ratio with T2D was observed (OR = 19.57, 95% CI = 3.26-117.42, per unit VFA/SFA), although the estimate was imprecise. CONCLUSIONS: The amount of subcutaneous adipose tissue was inversely associated with T2D, and the ratio of the amount of visceral adipose tissue to the amount of subcutaneous adipose tissue was positively associated with T2D in breast cancer patients.

The risks and responsible roles for psychiatrists who interact with the media.

Journalists often turn to psychiatrists for analysis of medical, social, political, and cultural events that involve human behavior and illness. Once journalists seek their expertise, psychiatrists often rush to be helpful, which can lead to ineffective performance and to statements that may run afoul of principles of professional ethics. In this article, we discuss the bases on which the professionalism of psychiatrists may be impugned when they commit errors in their media presentations. Found within the Principles of Medical Ethics with Special Annotations Especially Applicable to Psychiatry, the Goldwater Rule prohibits certain behaviors when psychiatrists share professional opinions with the public. We first discuss the Goldwater Rule, highlighting the events that led to its development and the professional response to its enactment. We then present a method to guide psychiatrists in their interaction with the media that will help them avoid violating ethics principles or the law. The method encourages knowledge of a framework of ethics principles that in turn guide the psychiatrist's behavior and thinking as he contemplates accepting invitations to interact with the media. The ethics-based roles include the Teacher, the Storyteller, the Celebrity Commentator, the Hollywood Consultant, the Clinician, and the Advertiser.

Evaluating the workload of on-call psychiatry residents: which activities are associated with sleep loss?

OBJECTIVE: The purpose of this study was to review the workload inventory of on-call psychiatry residents and to evaluate which activities were associated with reductions in on-call sleep. METHOD: A prospective cohort study was conducted, following 20 psychiatry residents at a 231-bed psychiatry hospital, from July 1, 2008 through June 30, 2009. On-call activities and hours of sleep received were recorded on log sheets. RESULTS: From the 2008-2009 academic year, 298 on-call log sheets were received (81.64% response rate). The mean hours of sleep per night received by participating residents was 3.52 hours. The mean number of pages received was 17.21 per night. The variance in hours of sleep was explained by the number of pages and the number of admissions. CONCLUSION: Given the new standards established by the Accreditation Council for Graduate Medical Education, residency directors can increase on-call sleep for residents by reducing the number of pages and admissions.

From the archives of the AFIP: pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) may develop in a primary (idiopathic) form, chiefly during middle age, or less commonly in the setting of inhalational exposure, hematologic malignancy, or immunodeficiency. Current research supports the theory that PAP is the result of pathophysiologic mechanisms that impair pulmonary surfactant homeostasis and lung immune function. Clinical symptomatology is variable, ranging from mild progressive dyspnea to respiratory failure. There is a strong association with tobacco use. The predominant computed tomographic feature of PAP is a "crazy-paving" pattern (smoothly thickened septal lines on a background of widespread ground-glass opacity), often with lobular or geographic sparing. The radiologic differential diagnosis of crazy-paving includes pulmonary edema, pneumonia, alveolar hemorrhage, diffuse alveolar damage, and lymphangitic carcinomatosis. Definitive diagnosis is made with lung biopsy or bronchoalveolar lavage specimens that reveal intraalveolar deposits of proteinaceous material, dissolved cholesterol, and eosinophilic globules. Symptomatic treatment includes whole-lung lavage, and multiple procedures may be required. New therapies directed toward the identified defect in immune defense have met with moderate clinical success.