QJM: An International Journal of Medicine

Parimon, T; Espindola, M; Marchevsky, A; Rampolla, R; Chen, P; Hogaboam, C M

doi: 10.1093/qjmed/hcac206pmid: 36018274

Pulmonary fibrosis is a sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection that currently lacks effective preventative or therapeutic measures. Post-viral lung fibrosis due to SARS-CoV-2 has been shown to be progressive on selected patients using imaging studies. Persistent infiltration of macrophages and monocytes, a main feature of SARS-CoV-2 pulmonary fibrosis, and long-lived circulating inflammatory monocytes might be driving factors promoting the profibrotic milieu in the lung. The upstream signal(s) that regulates the presence of these immune cells (despite complete viral clearance) remains to be explored. Current data indicate that much of the stimulating signals are localized in the lungs. However, an ongoing low-grade systemic inflammation in long Coronavirus Disease 2019 (COVID-19) symptoms suggests that certain non-pulmonary regulators such as epigenetic changes in hematopoietic stem cells might be critical to the chronic inflammatory response. Since nearly one-third of the world population have been infected, a timely understanding of the underlying pathogenesis leading to tissue remodeling is required. Herein, we review the potential pathogenic mechanisms driving lung fibrosis following SARS-CoV-2 infection based upon available studies and our preliminary findings (Graphical abstract).

Hou, L; Zhang, M; Liu, L; Zhong, Q; Xie, M; Zhao, G

doi: 10.1093/qjmed/hcac210pmid: 36063067

The endothelial cells not only constitute the barrier between the blood and interstitial space, but also actively regulate vascular tone, blood flow and the function of adjacent parenchymal cells. The close anatomical relationship between endothelial cells and highly vascularized metabolic organs suggests that the crosstalk between these units is vital for systemic metabolic homeostasis. Here, we review recent studies about the pivotal role of endothelial cells in metabolic diseases. Specifically, we discuss how the dysfunction of endothelial cells directly contributes to the development of insulin resistance, type 2 diabetes mellitus, atherosclerosis and non-alcoholic fatty liver disease via communication with parenchymal cells. Furthermore, although many biological macromolecules have been shown to ameliorate the progression of metabolic diseases by improving endothelial function, the low solubility, poor bioavailability or lack of specificity of these molecules limit their clinical application. Given the advantages in drug delivery of nanomedicine, we focus on summarizing the reports that improving endothelial dysfunction through nanomedicine-based therapies provides an opportunity for preventing metabolic diseases.

Teh, J W; O’Keeffe, S T

doi: 10.1093/qjmed/hcac256pmid: 36367283

Verbs can be transitive or intransitive (although some can be both). A transitive verb requires an object to make sense and is so-called because an action is transmitted from a subject to an object. In contrast, an intransitive verb cannot take an object. Several writers have commented on—and criticized—the use by healthcare professionals of the intransitive verb ‘consent’ (‘The patient consented to the operation’) as a transitive verb (‘I consented the patient’ or ‘The patient was consented by me’).1–3 We used the advanced search facility in Google Scholar to examine use of the exact phrases ‘patients were consented’ and ‘patients consented to’ in the English language medical literature from 1980 to 2021. The first example of ‘patients were consented’ was found in 19904 but it remained a sporadic usage until rising rapidly after 2000 (Figure 1). From 1995 to 2000, there was an average 34.2 uses of ‘patients consented to’ for every ‘patients were consented’; this had fallen to 2.3 for 2015–2020. Usually, it was reported that patients ‘were consented for’ a procedure or clinical trial but sometimes they ‘were consented for’ a complication, including death. Examples were found in almost all the most prestigious English language medical journals. Figure 1. Open in new tabDownload slide Use of ‘patients were consented’ and ‘patients consented to’ in the medical literature from 1980 to 2021. The increasing use of consent as a transitive verb in the medical literature—where writers will try to choose their words carefully, and where their choices must survive the scrutiny of reviewers and editorial staff—is disappointing and shows how pervasive and accepted this usage has become in practice. Language constantly evolves and even if a change is decried initially as ungrammatical it may become so established as to become irreversible. The main problem with the transitive use of consent is not just that it is poor grammar but that it misrepresents and subverts the meaning of consent. Patients give (or withhold) their consent to healthcare professionals after receiving adequate information about a proposed intervention: they are ultimately in control.3 In contrast, the transitive use suggests that consent is something that is ‘done to’ or ‘taken from’ patients. This is disrespectful and carries implications of a routine procedure on a relatively passive recipient, as in the stereotype of the junior doctor ‘consenting’ a patient by seeking a hurried signature on a consent form. Indeed, one online dictionary, recognizing this usage as specific to medicine, defines the transitive form of consenting as ‘To cause to sign a consent form’.5 It is true that sloppy use of language around consent by practitioners does not necessarily mean that actual consent practices are inadequate. However, as Wittgenstein noted,6 ‘the meaning of a word is its use in the language’. Language can reflect and shape attitudes. Consider, for example, the connotations, and unacceptability, of ‘I consented him/her for sex’. We believe the use of consent in healthcare as a transitive verb should be challenged and resisted. Avoidance of this usage in medical journals would be a start. Conflict of interest: None declared. References 1 Aronson J. Patient centred verbs . Br Med J 2002 ; 325 : 387 . Google Scholar Crossref Search ADS WorldCat 2 Wald DS , Kelly P. Medical consent; striking the right balance between shared decision-making and shared responsibility . Quart J Med 2021 ; 114 : 689 – 90 . Google Scholar Crossref Search ADS WorldCat 3 Alexander NA. Consent should not be transitive . Emerg Med J 2021 ; https://emj.bmj.com/content/consent-should-not-be-transitive (6 November 2022, date last accessed). Google Scholar OpenURL Placeholder Text WorldCat 4 Parker WH , Berek JS. Management of selected cystic adnexal masses in postmenopausal women by operative laparoscopy: a pilot study . Am J Obstet Gynecol 1990 ; 163 : 1574 – 7 . Google Scholar Crossref Search ADS PubMed WorldCat 5 Consent. https://en.wiktionary.org/wiki/consent (6 November 2022, date last accessed). 6 Wittgenstein L. Philosophical Investigations . (Translated by Anscombe GEM). 3rd edn. Oxford , Blackwell Publishing , 2001 , 73 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC © The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: [email protected]

Subedi, D; Subedi, S; Acharya, K P; Sah, R

doi: 10.1093/qjmed/hcac263pmid: 36448704

Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. Article PDF first page preview Close PDF This content is only available as a PDF. © The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. for permissions, please email: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. for permissions, please email: [email protected]

Goel, K; Sen, A; Satapathy, P; Asumah, M N; John, O O; Padhi, B K; Sah, R

doi: 10.1093/qjmed/hcac266pmid: 36448691

Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. Article PDF first page preview Close PDF This content is only available as a PDF. © The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. for permissions, please email: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. for permissions, please email: [email protected]

La Marca, A; Biondino, D; Gioia, M; De Luca, M

doi: 10.1093/qjmed/hcac285pmid: 36579858

Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. Article PDF first page preview Close PDF This content is only available as a PDF. © The Author(s) 2022. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. for permissions, please email: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)