Clinical medicine (London, England)
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Subclinical hypothyroidism (SCH) is a common condition seen in up to 10% of adults, mainly women and the elderly. Several prospective longitudinal cohort studies have shown a higher risk of cardiovascular disease in people with SCH but mainly in younger individuals. ⋯ In addition, there is increasing proof concerning the association of abnormal thyroid function at the time of an acute myocardial infarction with adverse cardiovascular outcomes. This review describes the literature dealing with thyroid function in relation to cardiovascular disease and also outlines the effect of treatment in addressing cardiovascular risk.
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IgG4-related disease (IgG4-RD) is increasingly recognised in Western societies as a multi-system, inflammatory, fibrosing disease of unknown aetiology that typically, though not exclusively, presents in older men. The clinical manifestations are diverse and almost any organ may be affected. The cardinal histological features are a lymphoplasmacytic infiltrate, storiform fibrosis, obliterative phlebitis and an abundance of IgG4+ plasma cells in affected organs. ⋯ Extending our understanding of the role of IgG4 immunoglobulins in health and disease, the assessment of B and T cell immune phenotype, and large genetic studies of IgG4-RD may enhance our understanding of disease pathogenesis. Ultimately it may be that there is not a single, simple unifying aetiology and so careful stratification of disease by clinical phenotype will be required in multi-centre prospective clinical cohorts. These cohorts will also be essential for the study of treatment outcomes with novel therapies.
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Primary immunodeficiencies (PID) are a group of rare inherited disorders that manifest as heightened susceptibility to infection, autoimmunity and/or malignancy. By exploring their genetic and cellular aetiology, we can learn much about the basis of pathogen-specific immunity in humans. ⋯ In recent years, the discovery of novel forms of PID has emphasised the important role of dendritic cells and monocytes in mycobacterial defence in humans. Here, we provide a brief overview of these new disorders alongside other genetic causes of susceptibility to mycobacterial disease.
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Our knowledge of the morphological heterogeneity of cancer has recently been augmented by the genomic heterogeneity revealed by the use of next-generation sequencing technology. We now know that no two cancers are alike and that even different regions within the same tumour vary in their composition. Tumours consist of multiple clonal populations and they evolve under Darwinian principles. This review summarizes some of the causes of such diversity and its implication for cancer management.
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Renal sympathetic denervation is a novel, endovascular treatment with potential utility in resistant hypertension. First pioneered in humans in 2010, conflicting data exist regarding the efficacy of this treatment. This article will review the evidence to date, the scientific rationale for sympathetic denervation as a treatment for hypertension and consider other possible conditions where the therapy may be of benefit.