Gargantuan Left Atrium: A Sequela of Mitral Regurgitation and Mitral Stenosis

Cardiac magnetic resonance imaging and echocardiography revealed a gargantuan left atrium measuring 18.9 cm × 15.7 cm × 11.3 cm in a 56‐year‐old patient diagnosed with severe rheumatic mitral stenosis, severe pulmonary hypertension, and permanent atrial fibrillation. A chest x‐ray also revealed a cardiothoracic ratio approaching 1.0 and a transthoracic echocardiogram measured diameters as large as 19.2 cm. The patient then underwent mitral valve replacement and left atrial reduction surgery and has had no further admissions or complications.     

Borrelia burgdorferi RevA Significantly Affects Pathogenicity and Host Response in the Mouse Model of Lyme Disease

The Lyme disease spirochete, Borrelia burgdorferi, expresses RevA and numerous outer surface lipoproteins during mammalian infection. As an adhesin that promotes bacterial interaction with fibronectin, RevA is poised to interact with the extracellular matrix of the host. To further define the role(s) of RevA during mammalian infection, we created a mutant that is unable to produce RevA. The mutant was still infectious to mice, although it was significantly less well able to infect cardiac tissues. Complementation of the mutant with a wild-type revA gene restored heart infectivity to wild-type levels. Additionally, revA mutants led to increased evidence of arthritis, with increased fibrotic collagen deposition in tibiotarsal joints. The mutants also induced increased levels of the chemokine CCL2, a monocyte chemoattractant, in serum, and this increase was abolished in the complemented strain. Therefore, while revA is not absolutely essential for infection, deletion of revA had distinct effects on dissemination, arthritis severity, and host response.     

Incontinence,Voiding Dysfunction,and Other Urologic Complications After Radiotherapy for Gynecologic Malignancies

Women with newly diagnosed gynecologic cancer will undergo treatment with surgery, radiation, or combination therapy. A considerable proportion of these women will develop urologic complications including urinary incontinence, urinary retention, radiation cystitis, ureteral stricture, or genitourinary fistula. Diagnosis is typically made with a careful history, physical exam, endoscopy, urodynamics, and imaging. Non-surgical and surgical management of urologic complications following radiotherapy is complicated by local tissue damage resulting in inferior success rates when compared to the general population. It is imperative that the patient and physician understand the complexity of treatment and manage expectations accordingly.     

Crime and Violence among MDMA Users in the United States

The question of whether MDMA use is associated with increased crime and violence has not been adequately explored especially in nationally representative samples. This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to assess the association between MDMA use and violent and non-violent antisocial behavior while controlling for sociodemographic variables, lifetime psychiatric, alcohol and drug use disorders, and family history of antisocial behavior. MDMA users, both male and female, were involved in a number of crimes in acts of violence including drunk driving, shoplifting, theft, intimate partner violence, and fighting. Notably, female MDMA users were more antisocial than male non-MDMA users. Although adjusting the results for numerous confounds attenuated the relationships, MDMA users were still at significantly greater odds of engaging in violent and nonviolent crime than non-MDMA users. Although MDMA has been considered a facilitator of empathy and closeness, the current study suggests a dark side as MDMA is associated with a broad array of crimes and transgressions. Additional tests of the MDMA-crime link are needed to properly inform policy.