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Publisher: Elsevier   (Total: 3042 journals)

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Showing 1 - 200 of 3042 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 19, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 325, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 204, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 22, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 123, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 45, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 20, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 34, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 21, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 58)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 338, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 307, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 422, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 50, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 10, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 47, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 44, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 44, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 179, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 33, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 53, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 5)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 160, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 152, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of the Medical Sciences
  [SJR: 0.653]   [H-I: 70]   [12 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9629
   Published by Elsevier Homepage  [3042 journals]
  • Dextrocardia With Situs Inversus and Levo-Transposition of Great Vessels
    • Authors: Qurat Ul Ain Riaz Sipra; Jawad Bilal; Muhammad Husnain
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Qurat Ul Ain Riaz Sipra, Jawad Bilal, Muhammad Husnain


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.10.007
       
  • Benign-Appearing Pheochromocytoma With Late Recurrence
    • Authors: Abhilash Koratala; Deepti Bhattacharya; Dara N. Wakefield
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Abhilash Koratala, Deepti Bhattacharya, Dara N. Wakefield


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.11.011
       
  • Renal Infarction due to Renal Artery Dissection: A Diagnostic Challenge
    • Authors: Yu-Mei Cheng; Der-Cherng Tarng; Chih-Yu Yang
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Yu-Mei Cheng, Der-Cherng Tarng, Chih-Yu Yang


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.11.006
       
  • AJMS – 10 Years of Growth
    • Authors: David W. Ploth
      First page: 509
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): David W. Ploth


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.05.004
       
  • Wireless: The Life and Death of Guglielmo Marconi
    • Authors: Harold Smulyan; Robert S. Pinals; Lisa Pinals; Daniel Villarreal
      Pages: 511 - 515
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Harold Smulyan, Robert S. Pinals, Lisa Pinals, Daniel Villarreal
      With little training in physics, Guglielmo Marconi developed the invention that stunned the world by wirelessly connecting ships and continents. Ten years before his death, he sustained a myocardial infarction followed by unmistakable angina pectoris. His personality and unhappy family life limited his ability to cope with his disease and to deal with Italy's most respected physicians. But their descriptions of his diagnosis and management are surprisingly few. Poor record keeping, intentional news suppression of his failing health or limited medical opportunities could be the reason for this lack of information. He died in 1937 when the value of electrocardiograms and X-rays were recognized (he had neither), but therapeutic options were severely limited. To gain insight into his care, we compared contemporary Italian understanding of coronary heart disease to British and American teachings. When he died of an acute coronary syndrome, heart failure and dysrhythmias, he was attended only by medical staff, but by none of his large family.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.12.022
       
  • Assessment Tools for Use During Anesthesia-Centric Pediatric Advanced Life
           Support Training and Evaluation
    • Authors: Scott C. Watkins; Paul J. Nietert; Elisabeth Hughes; Eric T. Stickles; Tracy E. Wester; Matthew D. McEvoy
      Pages: 516 - 522
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Scott C. Watkins, Paul J. Nietert, Elisabeth Hughes, Eric T. Stickles, Tracy E. Wester, Matthew D. McEvoy
      Background Pediatric perioperative cardiac arrests are rare events that require rapid, skilled and coordinated efforts to optimize outcomes. We developed an assessment tool for assessing clinician performance during perioperative critical events termed Anesthesia-centric Pediatric Advanced Life Support (A-PALS). Here, we describe the development and evaluation of the A-PALS scoring instrument. Methods A group of raters scored videos of a perioperative team managing simulated events representing a range of scenarios and competency. We assessed agreement with the reference standard grading, as well as interrater and intrarater reliability. Results Overall, raters agreed with the reference standard 86.2% of the time. Rater scores concerning scenarios that depicted highly competent performance correlated better with the reference standard than scores from scenarios that depicted low clinical competence (P < 0.0001). Agreement with the reference standard was significantly (P < 0.0001) associated with scenario type, item category, level of competency displayed in the scenario, correct versus incorrect actions and whether the action was performed versus not performed. Kappa values were significantly (P < 0.0001) higher for highly competent performances as compared to lesser competent performances (good: mean = 0.83 [standard deviation = 0.07] versus poor: mean = 0.61 [standard deviation = 0.14]). The intraclass correlation coefficient (interrater reliability) was 0.97 for the raters’ composite scores on correct actions and 0.98 for their composite scores on incorrect actions. Conclusions This study provides evidence for the validity of the A-PALS scoring instrument and demonstrates that the scoring instrument can provide reliable scores, although clinician performance affects reliability.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.09.013
       
  • Hepatitis C Treatment in Patients With Porphyria Cutanea Tarda
    • Authors: Ashwani K. Singal; Krishna V.R. Venkata; Sarat Jampana; Fakhar-Ul Islam; Karl E. Anderson
      Pages: 523 - 528
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Ashwani K. Singal, Krishna V.R. Venkata, Sarat Jampana, Fakhar-Ul Islam, Karl E. Anderson
      Background Hepatitis C virus (HCV) infection is a common susceptibility factor for porphyria cutanea tarda (PCT). Experience on HCV treatment in patients with PCT is limited. Recently, HCV treatment has improved with direct-acting antivirals (DAA). We review our experience on HCV treatment in patients with PCT with older and newer regimens. Materials and Methods A retrospective chart review was conducted. HCV treatment was attempted 22 times in 13 patients with PCT (5 attempts in 1, 2 in 5 and 1 in the other 7 patients). Results Before starting HCV treatment, PCT was in complete remission in 16, partial remission in 2, unknown status in 2 and active in 2 instances. PCT relapsed during therapy 6 times (all interferon-based regimens and 2 including telaprevir), 4 requiring treatment interruption. Treatment was interrupted for reasons other than PCT relapse in 2 patients treated with interferon-based regimens. To prevent PCT recurrence, hydroxychloroquine was continued during HCV therapy 6 times (3 interferon regimens, 2 ribavirin regimens without interferon and 1 DAA alone). Twelve patients achieved sustained viral response, 3 with interferon regimens and 9 with DAA. Two patients with active PCT were treated with DAA, with reduction of plasma porphyrins in 1 and normalization in the other at the end of HCV therapy. Conclusions HCV treatment regimens including interferon or ribavirin may precipitate PCT relapse. Hydroxychloroquine may be useful to prevent such relapses. In this limited experience, DAA were not associated with PCT relapse. Studies are needed to examine DAA as a primary PCT treatment in HCV-infected patients.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.03.007
       
  • The Effects of Pleural Plaques on Longitudinal Lung Function in
           Vermiculite Miners of Libby, Montana
    • Authors: Kathleen A. Clark; J. Jay Flynn; Wilfried J.J. Karmaus; Lawrence C. Mohr
      Pages: 533 - 542
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Kathleen A. Clark, J. Jay Flynn, Wilfried J.J. Karmaus, Lawrence C. Mohr
      Background This study was conducted to assess associations of pleural plaques (PP) and longitudinal lung function in vermiculite miners of Libby, Montana who are occupationally exposed to asbestos. High-resolution computed tomography (HRCT) was used to identify asbestos-related findings in former Libby vermiculite miners. We investigated annual lung function decline in miners with PP only and compared them to miners with normal HRCT findings. Materials and Methods HRCTs from 128 miners were categorized into the following 4 diagnostic groups: (1) normal computed tomography scan (n = 9); (2) PP only (n = 72); (3) PP and interstitial fibrosis (n = 26) and (4) additional HRCT abnormalities (n = 21) such as rounded atelectasis, diffuse pleural thickening, pleural effusions or pulmonary nodules or tumor >1cm in diameter. Random intercept and slope linear mixed-effect regression models identified differences in lung function decline between miners with asbestos-associated outcomes and those with normal HRCT. Models were adjusted for follow-up time, body mass index, smoking status, latent exposure period and employment years. Interactions for smoking status with age and smoking status with pleural plaque severity were examined. Results Miners with PP only did not have an accelerated decline in lung function between 40 and 80 years. Miners with PP and additional HRCT abnormalities displayed significantly accelerated declines in forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide (P = 0.05 and P < 0.01, respectively). Plaque severity did not affect lung function decline. However, smokers with extensive plaques displayed accelerated loss in diffusing capacity of the lungs for carbon monoxide and forced expiratory volume in 1 second when compared to nonsmoking miners with mild plaque formation. Conclusions PP alone did not significantly affect lung function decline in vermiculite miners of Libby, Montana.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.03.033
       
  • Soluble CD14 Subtype—A New Biomarker in Predicting the Outcome of
           Critically Ill Septic Patients
    • Authors: Giovanni Matera; Angela Quirino; Cinzia Peronace; Pio Settembre; Vito Marano; Maria T. Loria; Nadia Marascio; Luisa Galati; Giorgio S. Barreca; Aida Giancotti; Bruno Amantea; Maria C. Liberto; Alfredo Focà
      Pages: 543 - 551
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Giovanni Matera, Angela Quirino, Cinzia Peronace, Pio Settembre, Vito Marano, Maria T. Loria, Nadia Marascio, Luisa Galati, Giorgio S. Barreca, Aida Giancotti, Bruno Amantea, Maria C. Liberto, Alfredo Focà
      Background We evaluated the role of presepsin (soluble CD14 subtype, sCD14-ST) in predicting the outcome of critically ill septic patients in parallel with procalcitonin and C-reactive protein. Methods This study was an observational, prospective study that enrolled 58 surgical and medical intensive care unit patients with suspected sepsis. All studied subjects were retrospectively stratified into survivors and nonsurvivors based on 28 days survival and according to microbiological results in blood culture positive and negative groups. Plasma and serum samples from each patient were collected at admission (T-0), after 24-48 hours (T-1) and after 7 days (T-2). Statistics were obtained using Student׳s t test and ANOVA, as well as Bonferroni post hoc test. Receiver-operating characteristic (ROC) analysis was also performed. Results Presepsin levels were significantly higher at T-0 (P = 0.0007), at T-1 (P < 0.0001) and at T-2 (P < 0.0001) in nonsurvivors versus survivors at the same time point. Presepsin concentrations were significantly increased at T-0 (P = 0.0073), T1 (P = 0.0111) and T2 (P = 0.0167) in patients with positive blood cultures in comparison to patients with negative cultures at the same time. For all time periods evaluated, presepsin data from nonsurviving and surviving individuals were subjected to ROC analysis that demonstrated an excellent accuracy and significant area under the ROC curve (P < 0.0001). Results of multivariate analysis indicated presepsin as a predictive independent variable among prognosis markers at T-0 (P = 0.016). Conclusions Presepsin revealed an optimal prognostic performance in patients with severe sepsis and provided interesting diagnostic value. Prediction of outcome in critically ill patients is crucial to optimize management decisions and level of treatment.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.03.036
       
  • Alterations in Lipid Profile, Zinc and Copper Levels and Superoxide
           Dismutase Activities in Normal Pregnancy and Preeclampsia
    • Authors: Pardis Keshavarz; B. Fatemeh Nobakht M. Gh; Seyed Reza Mirhafez; Mohsen Nematy; Mohsen Azimi-Nezhad; Sedigheh Ayati Afin; Habibollah Esmaily; Leila Pourali; Atieh Mehdizadeh Hakak; Mohammad Soukhtanloo; Masoumeh Mirteimouri; Nayereh Ghomian; Gordon A. Ferns
      Pages: 552 - 558
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Pardis Keshavarz, B. Fatemeh Nobakht M. Gh, Seyed Reza Mirhafez, Mohsen Nematy, Mohsen Azimi-Nezhad, Sedigheh Ayati Afin, Habibollah Esmaily, Leila Pourali, Atieh Mehdizadeh Hakak, Mohammad Soukhtanloo, Masoumeh Mirteimouri, Nayereh Ghomian, Gordon A. Ferns
      Background Increased oxidative stress (OS) and lipid peroxidation may be involved in the pathogenesis of preeclampsia (PE). We conducted a case-control study to evaluate the levels of plasma lipids and trace elements as well as activity of superoxide dismutase (SOD) in PE. Materials and Methods The study consisted of 100 patients who had been diagnosed with PE and 100 normotensive pregnant women who underwent medical checkups that served as the control group. Lipid profile, zinc (Zn) and copper (Cu) levels and SOD activities were measured in the plasma of all subjects. Results Our results showed that the plasma levels of triglycerides and SOD activity were significantly elevated and the levels of Zn and Cu were significantly reduced in patients with PE compared with healthy controls. Increased levels of SOD may indicate antioxidant protective mechanisms against OS in PE-complicated pregnancies. This finding may suggest an involvement of OS in the pathophysiology of PE. Conclusion This study demonstrated a significant negative correlation between SOD activity and levels of trace elements. Furthermore, we suggest that higher triglyceride levels and SOD activity combined with lower Zn and Cu levels may be associated with an increased risk of PE.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.03.022
       
  • Surfactant Protein D Inhibits Interleukin-12p40 Production by Macrophages
           Through the SIRPα/ROCK/ERK Signaling Pathway
    • Authors: Rui Yamaguchi; Arisa Sakamoto; Takatoshi Yamamoto; Yasuji Ishimaru; Shinji Narahara; Hiroyuki Sugiuchi; Yasuo Yamaguchi
      Pages: 559 - 567
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Rui Yamaguchi, Arisa Sakamoto, Takatoshi Yamamoto, Yasuji Ishimaru, Shinji Narahara, Hiroyuki Sugiuchi, Yasuo Yamaguchi
      Objective Interleukin (IL)-12 has a pivotal profibrotic role in the development of idiopathic pulmonary fibrosis (IPF). Medical research trials based on IPF registry databases have actively recruited patients. Surfactant protein D (SP-D) is a useful biomarker in patients with IPF. SP-D binds to signal regulatory protein α (SIRPα), which acts as an inhibitory receptor, and this SP-D/SIRPα interaction may have an anti-inflammatory effect. Accordingly, the inhibitory effect of SP-D on IL-12p40 production by lipopolysaccharide (LPS)-stimulated macrophages was investigated. Materials and Methods Human granulocyte-macrophage colony-stimulating factor (GM-CSF)-stimulated macrophages (day 9 of culture) was used to investigate IL-12p40 production after stimulation with SP-D. Results GM-CSF was found to upregulate SIRPα expression by macrophages. PD98059 (an extracellular signal-regulated kinase [ERK] inhibitor) blunted induction of SIRPα expression by GM-CSF. SP-D significantly attenuated IL-12p40 production by macrophages after stimulation with LPS. Silencing of SIRPα/β/γ significantly reversed this inhibitory effect of SP-D. In contrast, neither SB023580 (a p38α/β MAPK inhibitor) nor BIRB796 (a p38γ/δ MAPK inhibitor) attenuated the inhibitory effect of SP-D on LPS-stimulated production of IL-12p40. Silencing of SHP also had no influence on this effect of SP-D. Interestingly, a Rho-associated protein kinase (ROCK) inhibitor (Y-27632) abolished the inhibition of LPS-stimulated IL-12p40 production by SP-D, whereas silencing of ERK 2 significantly blunted this effect of Y-27632. Conclusions These findings suggest that SP-D inhibits LPS-stimulated production of IL-12p40 via the SIRPα/ROCK/ERK signaling pathway.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.03.013
       
  • Fenofibrate Attenuates Hypertension in Goldblatt Hypertensive Rats: Role
           of 20-Hydroxyeicosatetraenoic Acid in the Nonclipped Kidney
    • Authors: Alexandra Sporková; Věra Čertíková Chábová; Šárka Doleželová; Šárka Jíchová; Libor Kopkan; Zdeňka Vaňourková; Elzbieta Kompanowska-Jezierska; Janusz Sadowski; Hana Maxová; Luděk Červenka
      Pages: 568 - 579
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Alexandra Sporková, Věra Čertíková Chábová, Šárka Doleželová, Šárka Jíchová, Libor Kopkan, Zdeňka Vaňourková, Elzbieta Kompanowska-Jezierska, Janusz Sadowski, Hana Maxová, Luděk Červenka
      Background There is vast evidence that the renin-angiotensin system is not the sole determinant of blood pressure (BP) elevation in human renovascular hypertension or the relevant experimental models. This study tested the hypothesis that kidney deficiency of 20-hydroxyeicosatetraenoic acid (20-HETE), a product of cytochrome P450 (CYP)-dependent ω-hydroxylase pathway of arachidonic acid metabolism, is important in the pathophysiology of the maintenance phase of 2-kidney, 1-clip (2K1C) Goldblatt hypertension. Materials and Methods In 2K1C Goldblatt rats with established hypertension, angiotensin II, angiotensin 1-7, 20-HETE concentrations and gene expression of CYP4A1 enzyme (responsible for 20-HETE formation) of the nonclipped kidney were determined. We examined if 14 days׳ administration of fenofibrate, a lipid-lowering drug, would increase CYP4A1 gene expression and renal 20-HETE formation, and if increased 20-HETE concentrations in the nonclipped kidney would decrease BP (telemetric measurements). Results CYP4A1 gene expression, 20-HETE and angiotensin 1-7 concentrations were lower and angiotensin II levels were higher in the nonclipped kidney of 2K1C rats than in sham-operated rats. Fenofibrate increased CYP4A1 gene expression and 20-HETE concentration in the nonclipped kidney and significantly decreased BP in 2K1C rats but did not restore it to normotensive range. The treatment did not change BP in sham-operated rats. Conclusions Our results suggest that alterations in the RAS and CYP-dependent ω-hydroxylase metabolites of arachidonic acid in the nonclipped kidneys are both important in the pathophysiology of the maintenance phase of 2K1C Goldblatt hypertension. Therefore, fenofibrate treatment effectively attenuated hypertension, probably via stimulation of 20-HETE formation in the nonclipped kidney.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.04.009
       
  • Effective Self-Management Interventions for Patients With Lupus: Potential
           Impact of Peer Mentoring
    • Authors: Edith M. Williams; Leonard Egede; Trevor Faith; James Oates
      Pages: 580 - 592
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Edith M. Williams, Leonard Egede, Trevor Faith, James Oates
      Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.01.011
       
  • Novel Findings in HIV, Immune Reconstitution Disease and Strongyloides
           stercoralis Infection
    • Authors: Roberto G. Aru; Benjamin M. Chilcutt; Saira Butt; Richard D. deShazo
      Pages: 593 - 596
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Roberto G. Aru, Benjamin M. Chilcutt, Saira Butt, Richard D. deShazo
      We report the successful treatment of an HIV-infected patient with progressive strongyloidiasis as a component of immune reconstitution disease and a review of the literature on this topic. In our experience, pre- and post-antiretroviral therapy intestinal biopsies support a novel mechanism of immune reconstitution disease to Strongyloides stercoralis. We conclude that extended, dual antihelminthic therapy and temporary discontinuation of antiretroviral therapy may be effective in similar patients.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.05.021
       
  • Left Main Coronary Artery Thrombosis With Acute Myocardial Infarction: A
           Management Dilemma
    • Authors: Natasha Purai Arora; Mouhammed Joumaa; Howard Rosman; Raj Mehta
      Pages: 597 - 602
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Natasha Purai Arora, Mouhammed Joumaa, Howard Rosman, Raj Mehta
      Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is a rare condition with very high mortality. The low incidence of this condition and exclusion of patients with LMCA thrombosis from clinical trials prevent the development of optimal management strategy in these patients. Therefore, there are no clear-cut guidelines describing an evidence-based approach for this condition. We describe a patient with LMCA thrombosis presenting with acute myocardial infarction, who was found to have hypercoagulable state related to homocysteinemia on further work-up. This case highlights the challenges faced during the management of this rare condition due to lack of clear-cut guidelines describing an evidence-based approach.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.04.022
       
  • Methemoglobinemia Caused by Indoxacarb Poisoning
    • Authors: Chin-Kai Yen; I-Ting Ku; Chien-Ming Chao; Chih-Cheng Lai
      Pages: 603 - 604
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Chin-Kai Yen, I-Ting Ku, Chien-Ming Chao, Chih-Cheng Lai


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.08.004
       
  • Burkholderia cepacia–Associated Hemorrhagic Pericardial Effusion
    • Authors: Faisal Inayat; Hafeez Ul Hassan Virk; Shumail Fatima; Steven Hobson; Eyal Herzog
      Pages: 605 - 606
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Faisal Inayat, Hafeez Ul Hassan Virk, Shumail Fatima, Steven Hobson, Eyal Herzog


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.10.013
       
  • Recurrence of Cytomegalovirus Viremia Causing Gastrointestinal Tract
           Bleeding at Different Sites in an Immuno-competent Patient
    • Authors: Tsung-Ta Chiang; Tzu-Chao Lin; Rui-Xin Wu; Chih-Chien Chiu; Ya-Sang Yang
      Pages: 607 - 609
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Tsung-Ta Chiang, Tzu-Chao Lin, Rui-Xin Wu, Chih-Chien Chiu, Ya-Sang Yang


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.11.008
       
  • Metastatic Hepatoid Carcinoma of the Pancreas: First Description of
           Treatment With Capecitabine and Temozolomide
    • Authors: Bruna Pellini Ferreira; Jonathan Vasquez; Allison Carilli
      Pages: 610 - 612
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Bruna Pellini Ferreira, Jonathan Vasquez, Allison Carilli


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.12.006
       
  • Ocular Manifestations of Blood Dyscrasias
    • Authors: Osama M. Mustafa; Patricio M. Aduriz-Lorenzo
      First page: 613
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Osama M. Mustafa, Patricio M. Aduriz-Lorenzo


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2016.09.001
       
  • Ischaemia Modified Albumin Test (IMA): To detect early diabetic
           complications
    • Authors: Kinjalka Ghosh; Manohar G. Muddeshwar; Kanjaksha Ghosh
      Abstract: Publication date: Available online 23 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Kinjalka Ghosh, Manohar G. Muddeshwar, Kanjaksha Ghosh
      Background The objective of this study was to assess the Albumin Cobalt Binding test in a cohort of type 2 diabetes patients. The ABC test is a simple, inexpensive, sensitive and robust test that could have important clinical application in detecting complications of type 2 diabetes mellitus. Materials and Methods We tested patients with Type 2 diabetes without any clinically detectable complicationsor without any other co-morbid conditions for serum ACB levels along with an equal number of age and sex matched healthy control subjects. ACB levels were compared after the patients with diabetes were investigated for various complications using standard statistical tests of significance. Results A total of 100 patients with Type 2 diabetes were studied with age and sex matched healthy control subjects. 78 of the 100 patients had different complications on detailed laboratory testing. The patients with complications had significantly higher ACB test results when compared to the patients with diabetes without complications and to that of the control subjects (0.62+/-0.04 , 0.42+/-0.07, 0.30+/-0.05 ABSU/ml respectively. P value < 0.001). All values in diabetics were significantly higher than that of controls. Conclusion The serum ACB test is a sensitive indicator of complications developed in type 2 diabetes mellitus. Patients may be followed-up with ACB results to detect early complications in this disease.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.06.017
       
  • Tuberculous Pleural Effusions: A New Look at An Old Problem
    • Authors: Umair Ahmad Gauhar
      Abstract: Publication date: Available online 21 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Umair Ahmad Gauhar


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.06.013
       
  • Propofol potentiates sevoflurane-induced inhibition of NF-κB-mediated
           inflammatory responses and regulation of MAPK pathways via TLR4 signaling
           in lipopolysaccharide-induced acute lung injury in mice
    • Authors: Wei Liu; Honghua Zhu; Hao Fang
      Abstract: Publication date: Available online 20 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Wei Liu, Honghua Zhu, Hao Fang
      Background Toll-like receptor 4 (TLR4)-induced initiation of mitogen-activated protein kinases (MAPKs) and the nuclear factor-kappa B (NF-κB) signaling cascade is reportedly involved in inflammatory responses during lung injury. Studies have found that volatile anesthetics, such as isoflurane and sevoflurane, inhibit inflammation. This investigation explored the protective effects of propofol and whether propofol potentiates the protective effects of sevoflurane against lipopolysaccharide (LPS)-induced acute lung injury (ALI). Methods Male BALB/c mice were treated with LPS (10μg/mouse; intranasal instillation) to induce ALI. Mice were exposed to sevoflurane (3 %; 6h) alone or combined with propofol (10 or 20mg/kg body weight; subcutaneously) followed by sevoflurane for 1h prior to the LPS challenge. Results Sevoflurane with or without propofol attenuated pulmonary edema, restored altered lung architecture, and reduced influx of inflammatory cells into bronchoalveolar lavage fluid after LPS challenge. LPS-mediated overproduction of the pro-inflammatory cytokines tumor necrosis factor-alpha, interleukin (IL)-1β, and IL-6, as well as nitric oxide, were reduced. Sevoflurane either alone or with propofol downregulated TLR4 and TLR4-mediated MAPK and NF-κB signaling. Conclusion Combined exposure to propofol and sevoflurane was more effective than sevoflurane administered alone, suggesting the positive effects of propofol on sevoflurane-mediated anti-inflammatory effects.

      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.06.012
       
  • Diabetes Related Dyslipidemia and Cardiovascular Events
    • Authors: Vivian A. Fonseca; Dragana Lovre
      Abstract: Publication date: Available online 19 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Vivian A. Fonseca, Dragana Lovre


      PubDate: 2017-06-24T02:47:36Z
      DOI: 10.1016/j.amjms.2017.06.011
       
  • A New Beginning
    • Authors: Jesse Roman
      Abstract: Publication date: June 2017
      Source:The American Journal of the Medical Sciences, Volume 353, Issue 6
      Author(s): Jesse Roman


      PubDate: 2017-06-24T02:47:36Z
       
  • Partially Purified Gloriosa Superba Peptides Inhibits Colon Cancer Cell
           Viability by Inducing Apoptosis Through p53 up-Regulation
    • Authors: Prapaphan Budchart; Ariya Khamwut; Chomdao Sinthuvanich; Sunanta Ratanapo; Yong Poovorawan; Nattanan Panjaworayan T-Thienprasert
      Abstract: Publication date: Available online 15 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Prapaphan Budchart, Ariya Khamwut, Chomdao Sinthuvanich, Sunanta Ratanapo, Yong Poovorawan, Nattanan Panjaworayan T-Thienprasert
      Background Colon cancer is a major health problem worldwide. Available treatments such as surgery, chemotherapy, radiation and anti-cancer drugs are limited due to stage of cancer, side effects and altered bio-distribution. The use of peptides extracted from natural products has appeared as a potential therapy. Gloriosa superba is known to contain colchicine and other alkaloids with anti-cancer activity. However, these peptides contained within the extracts have not been studied. This study therefore focuses on an investigation of anti-colon cancer activity from a partially purified protein hydrolysate of G. superba rhizome. Methods Dried G. superba rhizome was extracted using 0.5% SDS and digested with pepsin. The protein hydrolysates with molecular weight lesser than 3kDa were collected and subjected for cell viability assay. Then, the partial purification of the protein hydrolysate was performed using reverse-phase high performance liquid chromatography. Fractions containing anti-cancer peptides were investigated their effects on apoptosis and protein expression using apoptosis test and Western blot, respectively. Results and conclusions Results showed that partially purified peptides of G. superba rhizome demonstrated anti-colon activity in SW620 cells by inducing apoptosis through up-regulation of p53 and down-regulation of nuclear factor kappa B (NF- κB). Consequently, G. superba peptides showed high potential for further purification and development of anti-colon therapeutics.

      PubDate: 2017-06-18T22:38:01Z
      DOI: 10.1016/j.amjms.2017.06.005
       
  • Topical treatment of degenerative knee osteoarthritis
    • Authors: Zengdong Meng; Rongzhong Huang
      Abstract: Publication date: Available online 15 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Zengdong Meng, Rongzhong Huang
      This article reviews topical management strategies for degenerative osteoarthritis of the knee. A search of Pubmed, Embase, and the Cochrane library using MeSH terms including “topical,” “treatment,” “knee,” and “osteoarthritis” was carried out. Original research and review articles on the effectiveness and safety, recommendations from international published guidelines, and acceptability studies of topical preparations are included. Current topical treatments included for the management of knee OA include topical NSAIDs, capsaicin, and salicylates, and physical treatments such as hot/cold therapy. Current treatment guidelines recommend topical NSAIDs as an alternative and even first-line therapy for OA management, especially among elderly patients. Guidelines on other topical treatments vary, from recommendations against their use, to in favor as alternative or simultaneous therapy, especially for patients with contraindications to other analgesics. While often well-tolerated and preferred by many patients, clinical care still lags in the adoption of topical treatments. Aspects of efficacy, safety, and patient quality of life data require further research.

      PubDate: 2017-06-18T22:38:01Z
      DOI: 10.1016/j.amjms.2017.06.006
       
  • Is Myc an important biomarker' Myc expression in immune disorders and
           cancer
    • Authors: Shivtia Trop-Steinberg; Yehudit Azar
      Abstract: Publication date: Available online 15 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Shivtia Trop-Steinberg, Yehudit Azar
      The proto-oncogene Myc serves as a paradigm for understanding the dynamics of transcriptional regulation. Myc protein has been linked to immune dysfunction, cancer development, and neoplastic transformation. We review recent research regarding functions of Myc as an important modulator in immune disorders, post-allogeneic hematopoietic stem cell transplantation (HSCT), and several cancers. Myc overexpression has been repeatedly linked to immune disorders and specific cancers: myasthenia gravis, psoriasis, pemphigus vulgaris, atherosclerosis, long-term allogeneic survival among HSCT patients, (primary) inflammatory breast cancer, (primary) ovarian carcinoma, and hematological malignancies: acute myeloid leukemia, chronic myelogenous leukemia, Hodgkin′s lymphoma, and diffuse large B-cell lymphoma. However, decreased expression of Myc has been observed in HSCT patients who did not survive. Understanding impaired or inappropriate expression of Myc may present a path for the discovery of new targets for therapeutic applications.

      PubDate: 2017-06-18T22:38:01Z
      DOI: 10.1016/j.amjms.2017.06.007
       
  • Association Between MIC Gene Polymorphisms and Susceptibility of Systemic
           Lupus Erythematosus
    • Authors: Ping Yu; Quan Zhu; Chunjing Chen; Xiaoling Fu; Yu Li; Limin Liu; Qizhi Luo; Fuyan Wang; Yong Wang
      Abstract: Publication date: Available online 12 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Ping Yu, Quan Zhu, Chunjing Chen, Xiaoling Fu, Yu Li, Limin Liu, Qizhi Luo, Fuyan Wang, Yong Wang
      Background Major histocompatibility complex class I chain-related gene (MIC) polymorphisms have been associated with many autoimmune diseases. To explore the correlation between MIC polymorphisms and systemic lupus erythematosus (SLE), we compared the sequence of the MIC gene in Han Chinese SLE patients from Hainan Island, China with healthy individuals. Methods In this study, the MIC polymorphism in 296 subjects (159 SLE patients and 137 healthy volunteers) of Han ethnicity from Hainan Island was characterized. A χ2 test was performed to evaluate the differences in the allelic frequency of the MIC gene between SLE patients and the control subjects. Results The genotyping results indicated that the frequencies of the MICA*010, MICB*014, and MICB*002 alleles were significantly higher in the control subjects than the SLE patients. Additionally, the results also indicated that the frequency of the MICB*009N in the SLE group was significantly increased compared to that in the matched control subjects. Conclusions The results of this study suggested that the MICB*009N allele might be a risk factor for SLE whereas the MICB*014, MICA*010, and MICB*002 alleles were associated with reduced incidence of SLE in the study population.

      PubDate: 2017-06-13T19:25:15Z
      DOI: 10.1016/j.amjms.2017.06.003
       
  • Correlation Between TNF-α, IL- 1β in Exhaled Breath Condensate
           and Pulmonary Function
    • Authors: Xuefeng Lin; Yichu Fan; Xiaodong Wang; Mingyou Chi; Xin Li; Xun Zhang; Daqiang Sun
      Abstract: Publication date: Available online 12 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Xuefeng Lin, Yichu Fan, Xiaodong Wang, Mingyou Chi, Xin Li, Xun Zhang, Daqiang Sun
      Background Exhaled breath condensate (EBC) has emerged as a non-invasive method for assessing inflammation in lung diseases. Our aim is to investigate the correlation between TNF-α, IL- 1β in EBC and in lung tissue, and between these values in EBC with pulmonary function tests in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods To ensure availability of lung tissue, 60 patients undergoing resection for early lung cancer were divided into 3 groups, a COPD treatment group, a COPD control group and a non-COPD group. Patients in the COPD treatment group received what was termed “lung protective treatment” including ambroxol, budesonide, and ipratropium bromide in addition to chest physiotherapy. Patients underwent pulmonary function testing and EBC collection, and TNF-α and IL-1β were detected by ELISA. Tissue TNF-α and IL-1β in lung tissues were evaluated by immunoflorescense. Correlations were analyzed by Pearson correlation coefficients. Results The TNF-α and IL-1β levels in EBC were significantly higher in the COPD groups compared with the non-COPD group before surgery (all P < 0.01), and the levels were significantly decreased after lung protective treatment was received before surgery (all P < 0.01). TNF-α and IL-1β levels in EBC were significantly decreased in all patients after surgery with lung protective treatment (P = 0.027, P = 0.004). TNF-α and IL-1β content in lung tissues was significantly higher in the COPD groups (all P < 0.05), and the histological analysis showed similar results. Negative correlations between FEV1/FVC and expression of TNF-α /IL-1β were observed. There was a positive correlation between TNF-α/IL-1β in lung tissues and in EBC. Conclusions TNF-α and IL-1β in EBC are potential biomarkers for evaluating pulmonary function and inflammation in COPD patients. Furthermore, lung protective treatment is effective in reducing inflammation in COPD patients.

      PubDate: 2017-06-13T19:25:15Z
      DOI: 10.1016/j.amjms.2017.06.004
       
  • Involvement of resveratrol and ω-3 polyunsaturated fatty acids on Sirtuin
           1 gene expression in THP-1 cells
    • Authors: T. Tsuchiya; A. Endo; K. Tsujikado; T. Inukai
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): T. Tsuchiya, A. Endo, K. Tsujikado, T. Inukai
      Background Resveratrol, a kind of polyphenol, has potential to activate longevity gene in several cells, as same as calorie restriction does. We investigated the effect of resveratrol and ω-3 line polyunsaturated fatty acid (PUFA) on surtuin 1 (SIRT1) gene expression in human monocytes (THP-1) cells. Materials and Methods We examined the gene expression of THP1 cells using real-time PCR and Western blotting analysis. Resveratol, eicosapentaenoic acid (EPA) and docosahexaeanoic acid (DHA) as n-3 PUFA were added on THP-1 cells. We observed the changes in the SIRT-1 gene expression in those cells, under various doses of agents and in time courses. Then, we examined the interaction of glucose and mannitol on those agents′ effect of the gene expression. The concentration range of glucose and mannitol were from 5mM to 20mM, respectively. Results The SIRT1 gene expression could be defined in 24hr and 48hr. both in real-time PCR analysis and in Western blotting. Resveratrol showed SIRT1 gene expression in a dose-dependent manner in the range of 0μM and 20μM in both analyses. While, EPA at 10μM showed marked increase in SIRT1 gene expression compared with control condition in Western blotting, but this phenomenon was not in dose-dependent manner. DHA did not exhibit any augmentation of SIRT1 gene expression in dose-dependent manner in the range of 0μM and 20μM in both analyses. We refined the dose–dependent inhibition of the SIRT1 gene expression within 20mM glucose medium. While, 20mM did not any inhibition 10μM resveratrol-induced the gene expression compared to control medium. Both 5mM and 15mM Mannitol medium did not significantly altered basic and 10μM resveratrol-induced the gene expression. Conclusions The present results suggest that resveratrol and EPA, but not DHA, markedly activated the SIRT1 gene expression in THP-1 cells and then high glucose medium could inhibit the basic gene expression, but not powerful resveratrol-induced gene expression in those cells.

      PubDate: 2017-06-09T12:32:47Z
      DOI: 10.1016/j.amjms.2017.06.002
       
  • Extracellular microvesicles as game changers in better understanding the
           
    • Authors: Mariusz Z. Ratajczak; Janina Ratajczak
      Abstract: Publication date: Available online 8 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Mariusz Z. Ratajczak, Janina Ratajczak
      Recent research has led to wide acceptance and better understanding of a novel mechanism for cell–cell communication that employs a network of extracellular microvesicles (ExMVs). Derived from the plasma membrane or the endosomal membrane compartment, these small, spherical membrane fragments are secreted from the cell surface or in process of exocytosis from endosomal membrane compartment and 1) with ligands expressed on their surface directly stimulate target cells in a paracrine manner, 2) transfer cell membrane receptors to target cells, or 3) deliver encapsulated mRNA, miRNA, proteins, and bioactive lipids to target cells. This represents an evolutionarily ancient mechanism by which cells signal their presence in the microenvironment, communicate with each other, and affect the biology of neighboring cells. Evidence suggests the pivotal role of ExMVs in almost all biological processes within the body as well as their involvement in certain pathologies. Moreover, liquid biopsies based on deciphering the molecular signature of ExMVs promise to revolutionize laboratory diagnostics. At the same time there are ongoing attempts to employ them as delivery vehicles for drugs as well as therapeutics in regenerative medicine, oncology, and immunotherapy.

      PubDate: 2017-06-09T12:32:47Z
      DOI: 10.1016/j.amjms.2017.06.001
       
  • Hepatocellular Carcinoma: Hospitalizations and financial burden of a
           Decade in United States
    • Authors: Raxitkumar Jinjuvadia; Augustine Salami; Adrienne Lenhart; Kartikkumar Jinjuvadia; Suthat Liangpunsakul; Reena Salgia
      Abstract: Publication date: Available online 1 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Raxitkumar Jinjuvadia, Augustine Salami, Adrienne Lenhart, Kartikkumar Jinjuvadia, Suthat Liangpunsakul, Reena Salgia
      Background Despite a rise in the prevalence of hepatocellular carcinoma (HCC), data on HCC-related hospitalizations and financial burden are limited. The aim of this study is to evaluate temporal trends of HCC-related hospitalizations and evaluate its financial impact. Methods Patients with the diagnosis of HCC, as reported by ICD-9 code, were identified from the National Inpatient Sample (NIS) databases from 2002–2011. The national estimates of hospitalizations were derived using appropriate sample weights. The change in total average charges per each hospitalization over the study period was calculated after adjusting for inflation. Results Hospitalizations related to HCC have increased from 24,024 in 2002 to 50,609 in 2011. Of these admissions, HCC was the principal diagnosis in 10,762 and 16,350 subjects in 2002 and 2011, respectively. The majority were white males (male: 70%; white: 55%). The overall inpatient mortality was significantly decreased from 13.5% in 2002 to 9.9% in 2011 (p<0.01). The same trend was also observed for the length of hospital stay (6.5 vs. 5.6 days in 2002 and 2011). The inflation-adjusted cost per hospitalization increased by approximately 47% during the study period. Conclusion Despite the decrease in mortality rate and length of stay, hospitalizations and financial burden associated with HCC continue to increase over the past decade in the United States.

      PubDate: 2017-06-04T05:01:58Z
      DOI: 10.1016/j.amjms.2017.05.016
       
  • Multitudinous Gold Threads in the Whole Body
    • Authors: Jin Bae Lee; Seung Pyo Hong
      Abstract: Publication date: Available online 30 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Jin Bae Lee, Seung Pyo Hong


      PubDate: 2017-06-04T05:01:58Z
      DOI: 10.1016/j.amjms.2017.05.012
       
  • Prostaglandin-E2 induces prorenin-dependent activation of (Pro)renin
           receptor and upregulation of Cyclooxygenase-2 in Collecting Duct Cells
    • Authors: Nicolas Salinas-Parra; Cristian Reyes-Martinez; Minolfa C. Prieto; Alexis A. Gonzalez
      Abstract: Publication date: Available online 30 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Nicolas Salinas-Parra, Cristian Reyes-Martinez, Minolfa C. Prieto, Alexis A. Gonzalez
      Background Prostaglandin E2 (PGE2) regulates renin expression in renal juxtaglomerular cells. PGE2 acts through E-prostanoid (EP) receptors in the renal collecting duct (CD) to regulate sodium and water balance. CD cells express EP1 and EP4, which are linked to protein kinase C (PKC) and protein kinase A (PKA) downstream pathways, respectively. Previous studies showed that the presence of renin in the CD, and that PKC, and PKA pathways activate its expression. The (pro)renin receptor (PRR) is also expressed in CD cells and its activation enhances cyclooxygenase-2 (COX-2) through extracellular signal–regulated kinase (ERK). We hypothesized that PGE2 stimulates prorenin and renin synthesis leading to subsequent activation of PRR and upregulation of COX-2. Methods We used a mouse M-1 CD cell line that expresses EP1, EP3, and EP4 but not EP2. Results PGE2 (10–6 M) treatment increased prorenin and renin protein levels at 4 and 8h. No differences were found at 12h post PGE2 treatment. Phospho-ERK was significantly augmented after 12h. COX-2 expression was decreased after 4h of PGE2 treatment, but increased after 12h. Interestingly, the full-length form of the PRR was upregulated only at 12h. PGE2 mediated phospho-ERK and COX-2 upregulation was suppressed by PRR silencing. Conclusions Our results suggest that PGE2 induces biphasic regulation of COX-2 through renin-dependent PRR activation via EP1 and EP4 receptors. PRR-mediated increases in COX-2 expression may enhance PGE2 synthesis in CD cells serving as a buffer mechanism in conditions of activated renin angiotensin system.

      PubDate: 2017-06-04T05:01:58Z
      DOI: 10.1016/j.amjms.2017.05.018
       
  • Anal Fistulas Due to Pseudomyxoma Anorectum
    • Authors: Shuai Wang; Wan-Bin Yin; Ling-Yu Kong
      Abstract: Publication date: Available online 30 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Shuai Wang, Wan-Bin Yin, Ling-Yu Kong


      PubDate: 2017-06-04T05:01:58Z
      DOI: 10.1016/j.amjms.2017.05.019
       
  • Left Ventricular False Tendons are Associated with Left Ventricular
           Dilation and Impaired Systolic and Diastolic Function
    • Authors: Michael E. Hall; Joseph A. Halinski; Thomas A. Skelton; William F. Campbell; Michael R. McMullan; Robert C. Long; Myrna N. Alexander; James D. Pollard; John E. Hall; Ervin R. Fox; Michael D. Winniford; Daisuke Kamimura
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Michael E. Hall, Joseph A. Halinski, Thomas A. Skelton, William F. Campbell, Michael R. McMullan, Robert C. Long, Myrna N. Alexander, James D. Pollard, John E. Hall, Ervin R. Fox, Michael D. Winniford, Daisuke Kamimura
      Background Left ventricular false tendons (LVFTs) are chord-like structures that traverse the LV cavity and are generally considered to be benign. However, they have been associated with arrhythmias, LV hypertrophy and LV dilation in some small studies. Hypothesis LVFTs are associated with LV structural and functional changes assessed by echocardiography. Methods We retrospectively evaluated echocardiographic and clinical parameters of 126 patients identified as having LVFTs within the past 2 years and compared them to 85 age-matched controls without LVFTs. Results There were no significant differences in age (52±18 vs 54±18 years, p=0.37), sex (55 vs 59 % men, p=0.49), race (36 vs 23% white, p=0.07), systolic blood pressure (SBP, 131±22 vs 132±23mmHg, p=0.76) or body mass index (BMI, 31±8 vs 29±10kg/m2, p=0.07) between controls and patients with LVFTs, respectively. Patients with LVFTs had more prevalent heart failure (43% vs 21%, p=0.001). Patients with LVFTs had more LV dilation, were 2.5 times more likely to have moderate to severe mitral regurgitation, had more severe diastolic dysfunction and reduced LV systolic function (18% lower) compared with controls (all p<0.05). After adjustment for covariates, basal and middle LVFT locations were associated with reduced LV systolic function (p <0.01) and middle LVFTs were associated with LV dilation (p<0.01). Conclusions Our findings suggest LVFTs may not be benign variants and basal and middle LVFTs may have more deleterious effects. Further prospective studies should be performed to determine their pathophysiological significance and if they play a causal role in LV dysfunction.

      PubDate: 2017-05-30T00:23:53Z
      DOI: 10.1016/j.amjms.2017.05.015
       
  • The Underappreciated Doctors Of The American Civil Rights Movement. Part I
           Theodore Roosevelt Mason Howard, MD
    • Authors: Richard D. deShazo; Sara B. Parker
      Abstract: Publication date: Available online 26 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Richard D. deShazo, Sara B. Parker


      PubDate: 2017-05-30T00:23:53Z
      DOI: 10.1016/j.amjms.2017.05.017
       
  • Variation in normal ear temperature
    • Authors: Märta Sund Levander; Ewa Grodzinsky
      Abstract: Publication date: Available online 25 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Märta Sund Levander, Ewa Grodzinsky
      Background Variation in baseline ear temperature, taken in the unadjusted mode, has yet to be established in different age groups. Because normal body temperatures show large variations, the same may be expected for increased temperatures in fever. The aims were to study variations in normothermic body temperatures measured with an ear thermometer, and to determine differences between actual and perceived body temperature during a febrile episode (referred to as difftemp) in apparently healthy children and adults. Methods Ear temperature was measured once in 2006 individuals (61.7% female): 683 children aged 2 and 4 years, 492 adolescents aged 10 to 18, 685 adults aged 19 to 65, and 146 elderly aged 66 to 89 years. Difftemp was estimated as the difference between individual ear body temperature, measured in the present study, and the respondent′s reported temperature when feverish. Results Mean ear temperature was 36.4°C ± 0.6°C overall and in the child and adult groups. In adolescents, it was 36.5°C ± 0.5°C and in elderly, 36.1°C ± 0.5°C. Temperature in men was 36.3 ± 0.6°C and in women, 36.5 ± 0.5°C. difftemp was 1.1 ± 0.7°C in adolescents, 1.5 ± 0.7°C in children and adults, and 1.6 ± 0.7°C in those < 65 years. Conclusions Ear body temperature is lower than traditionally reported and differs with age and sex. An individual difftemp of 1.0°C to 1.5°C along with malaise might indicate fever.

      PubDate: 2017-05-30T00:23:53Z
      DOI: 10.1016/j.amjms.2017.05.013
       
  • Recurrence of Barcelona Clinic Liver Cancer Stage A Hepatocellular
           Carcinoma after Hepatectomy
    • Authors: Hao Zou; Cheng-zhan Zhu; Chang Wang; Zu-sen Wang; Xiang Ma; Bing Han; Li-qun Wu
      Abstract: Publication date: Available online 25 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Hao Zou, Cheng-zhan Zhu, Chang Wang, Zu-sen Wang, Xiang Ma, Bing Han, Li-qun Wu
      Background The Barcelona Clinic Liver Cancer (BCLC) staging system is widely used to classify hepatocellular carcinoma (HCC). This study is to investigate the prognostic factors for BCLC Stage A HCC patients after R0 hepatectomy. Methods A total of 592 BCLC Stage A HCC patients following R0 hepatectomy from 1997 to 2012 were enrolled in this study. Kaplan-Meier analysis and Cox regression were used to analyze the risk factors associated with recurrence. Receiver operating characteristic (ROC) curves were used to establish a new scoring system to evaluate the independent risk factors for recurrence. Furthermore, subgroup analyses were performed to evaluate surgical margins on tumor recurrence between the anatomical and non-anatomical resection group. Results Independent risk factors for BCLC Stage A HCC recurrence were preoperative alanine transaminase (ALT)>40U/L, liver cirrhosis, surgical margin <5mm, non-anatomic resection, and maximum tumor diameter>5cm. Based on these 5 risk factors, we established a new scoring system in this study, named “HCC recurrence scoring system”. Patients with a high score (≥3 points, 1 point for each factor) composed the high recurrence risk group. Moreover, the subgroup analyses demonstrated that different surgical margins had no significant effect on tumor recurrence in the anatomical resection group (P=0.408), while it had a significant effect in the non-anatomical resection group (P=0.000). Conclusions For BCLC Stage A patients with scores ≥3 points, close postoperative follow-up and positive measures to prevent recurrence are particularly important. Anatomical resection is preferred for BCLC Stage A patients. Adequate surgical margins are necessary for patients with poor liver function.

      PubDate: 2017-05-30T00:23:53Z
      DOI: 10.1016/j.amjms.2017.05.014
       
  • Streptococcus Anginosus Group Bacterial Infections☆☆
    • Authors: Tasaduq Fazili; Scott Riddell; Deana Kiska; Tim Endy; Luca Giurgea; Calden Sharngoe; Waleed Javaid
      Abstract: Publication date: Available online 24 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Tasaduq Fazili, Scott Riddell, Deana Kiska, Tim Endy, Luca Giurgea, Calden Sharngoe, Waleed Javaid
      Background The Streptococcus anginosus group (SAG) cause a variety of infections in adults. To better understand the burden of SAG infections and their associated morbidity and mortality, we conducted a retrospective analysis of these infections in adults at a tertiary care center. Methods A retrospective review of all cultures positive for SAG in adults and a corresponding review of their medical records was conducted at a tertiary care facility in Central New York. Patients with these cultures during the period of January 2007 to December 2011 were included. Demographic data, area of residence, clinical features and underlying illnesses, site of infection, length of hospital stay, antibiotic susceptibility and antibiotic therapy were recorded and analyzed. Results There were 332 SAG cases; the majority of patients were male (59%), mean age of 47 years, and 84% lived in urban areas. Overall mortality was 3% with underlying conditions common such as diabetes (25%), hypertension (31%) and immunodeficiency (22%). The majority of infections were skin and soft tissue (72%) and polymicrobial (70%) with gram negative anaerobes and Enterobacteriaceae commonly isolated with SAG. Conclusions We present the largest study thus far reviewing the clinical presentation, management and outcome of infections due to the Streptococcus anginosus group of organisms. Notable findings from our study are the low mortality associated with SAG infection, and the propensity to present as a skin, soft tissue and polymicrobial infection. Our findings will assist clinicians in managing patients with SAG infections and recognizing that strep anginosus may be one of several organisms responsible for infection.

      PubDate: 2017-05-24T18:56:11Z
      DOI: 10.1016/j.amjms.2017.05.011
       
  • Awareness of Individual Cardiovascular Risk Factors and Self-Perception of
           Cardiovascular Risk in Women
    • Authors: Jean-Jacques Monsuez; Tai Pham; Nicole Karam; Laurence Amar; Corinne Chicheportiche-Ayache; Philippe Menasché; Michel Desnos; Isabelle Weill
      Abstract: Publication date: Available online 23 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Jean-Jacques Monsuez, Tai Pham, Nicole Karam, Laurence Amar, Corinne Chicheportiche-Ayache, Philippe Menasché, Michel Desnos, Isabelle Weill
      Background Cardiovascular risk factors (CVRF) self-perception by women may be inaccurate. Methods A questionnaire was filled on an anonymous basis online by women who self-reported their personal CVRF levels, including age, weight, contraceptive use, menopausal status, smoking, diet, physical activities. Self-perceived risk was matched to actual cardiovascular risk according to the Framingham score. Results Among 5,240 young and middle-aged women with a high educational level, knowledge of personal CVRF increased with age, from 51% to 90% for blood pressure (BP), 22% to 45% for blood glucose, and 15 to 47% for blood cholesterol levels, between 30 and 65 years, respectively. This knowledge was lower for smoking compared with non-smoking women: 62.5 % vs 74.5% for BP (p<0.001), 22.7% vs 33.8% for blood glucose (p<0.001), 21.9 % vs 32.0% for cholesterol levels (p<0.001). Knowledge of BP level was reduced among women using an estrogen-progestogen contraception (56.8 vs 62.1%, p=0.0031) and even more reduced among smokers (52.2 %, p<0.001). Conversely, women with leisure-time physical or sportive activity (60.5%), had less overweight or obesity (22.4% vs 34.2%, p<0.001). They reported better knowledge of BP (72.4% vs 68.3%, p<0.001), blood cholesterol (31.1 % vs 26.4%, p<0.001), and glucose levels (32.7% vs 27.8%, p<0.001). Self-perceived cardiovascular risk was rated low by 1,279 (20.4%), moderate by 3,710 (63.3%), and high by 893 (16.3%) women. Among 3,386 women tested using the Framingham score, 40.8% were at low, 25.2% at moderate, and 33.8% at high risk. Conclusion Knowledge of CVRF and self-perception of individual risk are inaccurate in women. Educative interventions should be emphasized.

      PubDate: 2017-05-24T18:56:11Z
      DOI: 10.1016/j.amjms.2017.05.008
       
  • Cerebral Salt Wasting Syndrome: Diagnosis By Urine Sodium Excretion
    • Authors: Allen I. Arieff; Ramin Gabbai; Ira D. Goldfine
      Abstract: Publication date: Available online 20 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Allen I. Arieff, Ramin Gabbai, Ira D. Goldfine
      Background Cerebral salt wasting syndrome (CSWS) was initially described over 60 years ago in hyponatremic patients with a cerebral lesion. However, the diagnostic criteria for CSWS have not been fully established. Thus, when hyponatremia is observed in patients with CSWS, they may be misdiagnosed as having the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thus, it is critical to differentiate between these two conditions because their treatments are diametrically opposed. Methods We carried out a retrospective study of 45 patients with CSWS and compared them to 60 normonatremic control patients, and 28 patients with SIADH.  All patients had their 24hour urine volumes and Na excretion measured. Results Patients with either CSWS or SIADH had an elevated 24hour urine osmolality (above 350mOsm/kg). In patients with CSWS, urinary Na excretion was 394 ± 369mmol/24hour, and urinary volume was 2603 ± 996ml/24hour; both values significantly greater than in controls (p<0.01). By contrast, in patients with SIADH, the urine Na excretion was only 51± 25mmol/24hour and urine volume was 729 ± 488ml/24hour; values significantly lower than in patients with CSWS (p<0.01). Conclusions CSWS was diagnosed in patients with cerebral lesion who had: 1) symptomatic hyponatremia; 2) urine Na excretion 2SD above controls; and 3) increased urine volume. Patients with SIADH also had symptomatic hyponatremia but, in contrast to CSWS patients, they had decreased Na excretion and urine volume.  Thus urine Na excretion and volume are very important for diagnosing the cause of hyponatremia in patients with cerebral lesions.

      PubDate: 2017-05-24T18:56:11Z
      DOI: 10.1016/j.amjms.2017.05.007
       
  • Metformin has Positive Therapeutic Effects in Colon Cancer and Lung Cancer
    • Authors: DeAnna Henderson; Danielle Frieson; Jeffrey Zuber; Solomon S. Solomon
      Abstract: Publication date: Available online 19 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): DeAnna Henderson, Danielle Frieson, Jeffrey Zuber, Solomon S. Solomon
      Purpose Metformin, a diabetic drug, has anti-neoplastic activity as adjuvant therapy for breast cancer and prostate cancer. Metformin is thought to work via inhibition of mammalian target of rapamycin (mTOR) and activation of p53 and Liver Kinase B1 (LKB1) via 5′ adenosine monophosphate-activated protein kinase (AMPK). We investigated survival, recurrences, and metastasis in type 2 diabetes mellitus (DM2) patients with Colorectal cancer (CC) or Lung cancer (LC) taking metformin using the electronic medical record (EMR) in Memphis Veterans Affairs Medical Center (MVAMC) (N=202, Colon; N=180, Lung). Methods Patients with CC or LC and DM2 on metformin were compared to controls taking any medication except metformin. Recurrences, metastases, secondary cancers, survival, and CEA levels were compared using T-tests and chi square tests. Inclusion criteria was based on metformin use, CC or LC diagnosis, and DM2. Results For CC, the metformin group noted fewer deaths (48% vs 76%, p<0.001), recurrences (4% vs 19%, p= 0.002), metastases (23% vs 46%, p=0.001), better 5-year survival rates (57% vs 37%, p=0.004), overall survival years (5.7 vs 4.1, p=0.007), and grater CEA decrease (72% vs 47%, p=0.015). Metformin was associated with improved 5-year survival rates (29% vs 15%, p=0.023) and overall survival years (3.4 vs 1.8, p<0.001) in LC. Conclusions Our study shows metformin therapy is associated with significantly better prognosis in patients with CC and improved survival in LC. CC patients on metformin had fewer recurrences and metastases. Differences in metabolic pathways between CC and LC likely account for differences in effect of metformin.

      PubDate: 2017-05-24T18:56:11Z
      DOI: 10.1016/j.amjms.2017.05.006
       
  • Role of Microalbuminuria in Predicting Cardiovascular Mortality in
           Individuals with Subclinical Hypothyroidism
    • Authors: Tushar A Tuliani; Maithili Shenoy; Kevin Belgrave; Abhishek Deshmukh; Sadip Pant; Anthony Hilliard; Luis Afonso
      Abstract: Publication date: Available online 13 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Tushar A Tuliani, Maithili Shenoy, Kevin Belgrave, Abhishek Deshmukh, Sadip Pant, Anthony Hilliard, Luis Afonso
      Purpose Studies suggest subclinical hypothyroidism is related to cardiovascular mortality (CVM). We explored the role of microalbuminuria (MIA) as a predictor of long term CVM in population with and without subclinical hypothyroidism with normal kidney function. Methods We examined the NHANES-III database (n=6812). Individuals <40 years, TSH levels ≥20 and ≤0.35mIU/L, eGFR<60ml/min/1.73m2 and urine albumin to creatinine ratio (UCR) of >250mg/g in men and >355mg/g in women were excluded. Subclinical hypothyroidism was defined as TSH levels between 5–19.99 mIU/L and serum T4 levels between 5–12µg/dl. MIA was defined as UCR of 17–250mg/g in men and 25–355mg/g in women. Patients were categorized into 4 groups: (1) No subclinical hypothyroidism or MIA, (2) MIA, but no subclinical hypothyroidism, (3) Subclinical hypothyroidism, but no MIA, and (4) both Subclinical hypothyroidism and MIA. Results Prevalence of MIA in the subclinical hypothyroid cohort was 21% compared to 16.4% in those without subclinical hypothyroidism. (P=0.03) Subclinical hypothyroidism was a significant independent predictor of MIA (n=6812), after adjusting for traditional risk factors (unadjusted OR-1.75, 95% CI - 1.24–2.48, p-value-0.002; adjusted OR-1.83, 95% CI – 1.2–2.79, p-Value-0.006). Microalbuminuria was a significant independent predictor of long-term all-cause (Adjusted HR-1.7, 95% CI-1.24–2.33) and CVM (Adjusted HR-1.72, 95% CI-1.07–2.76) in subclinical hypothyroid individuals. Conclusion In a cohort of subclinical hypothyroid individuals, presence of MIA predicts increased risk of CVM as compared to non-microalbuminurics with subclinical hypothyroidism. Further randomized trials are needed to assess the benefits of treating microalbuminuric subclinical hypothyroid individuals and impact on CVM.

      PubDate: 2017-05-14T18:12:10Z
      DOI: 10.1016/j.amjms.2017.04.022
       
  • Bedside Blood Glucose Monitoring in Critically Ill Patients: comparison
           between arterial and capillary glucose
    • Authors: Xu Li; Yanquan Ma; Tianlu Chen; Jie Tang; Xiaochun Ma
      Abstract: Publication date: Available online 13 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Xu Li, Yanquan Ma, Tianlu Chen, Jie Tang, Xiaochun Ma
      Background Critically ill patients are at high risk of hypoglycemia and are particularly vulnerable to unrecognized hypoglycemia. Close blood glucose monitoring is therefore crucial. There are several options to conduct frequent blood glucose measurement and a number of conditions in Intensive Care Unit patients may affect the accuracy of blood glucose measurement. The aim of the study was to compare the accuracy of capillary glucose by bedside glucometer with arterial samples by bedside glucometer and arterial samples by blood gas analyzer in critically ill patients through a prospective case-control study. Methods Arterial and capillary samples from 60 patients were taken simultaneously and were tested immediately at the bedside. Results of the paired measurements were compared and expressed as a correlation coefficient. Results Capillary glucose in the study group and control group were 9.73±2.28mmol/l and 8.9±1.86mmol/l, respectively; mean arterial glucose measured by glucometer in the study group and control group were 9.25±2.05mmol/l and 8.4±1.89mmol/l, respectively; and mean arterial glucose measured by blood gas analyzer in the study group and control group were 8.41±1.99mmol/l and 8.24±1.58mmol/l, respectively. Correlation between capillary values and arterial values measured by glucometer was less in the study group (r=0.936, P<0.001 and r=0.973, P<0.001). Correlation between capillary values measured by glucometer and arterial values measured by blood gas analyzer was also less in the study group (r=0.897, P=0.001 and r=0.964, P<0.001). Conclusions Capillary blood glucose monitoring is reliable only in a selected group of critically ill patients.

      PubDate: 2017-05-14T18:12:10Z
      DOI: 10.1016/j.amjms.2017.05.005
       
  • Risk of Ischemic Heart Disease in Patients with Sjögren′s
           Syndrome
    • Authors: Faraz Khan Luni; Sonia Ali Malik; Abdur Rahman Khan; Haris Riaz; Hemindermeet Singh; Douglas Federman; Yusuf Kanjwal; Osama Dasa; Sadik Khuder; Ameer Kabour
      Abstract: Publication date: Available online 4 May 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Faraz Khan Luni, Sonia Ali Malik, Abdur Rahman Khan, Haris Riaz, Hemindermeet Singh, Douglas Federman, Yusuf Kanjwal, Osama Dasa, Sadik Khuder, Ameer Kabour
      Background Ischemic heart disease (IHD) has emerged as a major cause of morbidity and mortality in patients with autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis, but the risk of IHD in Sjögren′s Syndrome (SjS) is unknown. To fill this knowledge gap, we estimated the prevalence and risk of IHD with SjS compared to controls from the general population using Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample 2011 database. Methods The HCUP administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits and ambulatory surgery in all the United States hospitals. We conducted a cross sectional study among the inpatient population diagnosed with SjS and matched 1:4 with controls for age, gender and hospital region. Odds ratio (OR) for IHD was calculated as cases compared to controls. The contribution of various risk factors to IHD were also evaluated by logistic regression. Results Analysis demonstrated that 7,154 of 13,086 cases (54.7%) of SjS had IHD compared to 27,367 of 52,448 controls (52.2%). The adjusted OR for IHD in those with SjS is 0.898 (95% CI of 0.844–0.955). Patients with Sjs were significantly more likely to have hypertension, diabetes, apnea and lipid disorders. Conclusion To our knowledge, this is the largest population-based study investigating the risk of IHD in patients with SjS. We found a modest though statistically significant decrease in the risk of IHD in SjS compared to controls.

      PubDate: 2017-05-09T17:24:32Z
      DOI: 10.1016/j.amjms.2017.05.001
       
 
 
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