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Publisher: Elsevier   (Total: 3182 journals)

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Showing 1 - 200 of 3182 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 442, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 29, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 318, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 187, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 425, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 387, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 481, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 265, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 211, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of the Medical Sciences
Journal Prestige (SJR): 0.767
Citation Impact (citeScore): 1
Number of Followers: 12  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9629
Published by Elsevier Homepage  [3182 journals]
  • Ivermectin augments the in vitro and in vivo efficacy of cisplatin in
           epithelial ovarian cancer by suppressing Akt/mTOR signaling
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of the Medical SciencesAuthor(s): Xiaohong Zhang, Tingting Qin, Zhengyan Zhu, Fan Hong, Yang Xu, Xiongjie Zhang, Xiaohong Xu, Aiping Ma Background: The poor outcomes in epithelial ovarian cancer necessitate new treatments. In this work, we systematically analyzed the inhibitory effects of ivermectin and the molecular mechanism of its action in ovarian cancer.Methods: The effects of ivermectin alone and its combination with cisplatin on growth and survival were examined using cultured ovarian cancer cells and a xenograft mouse model. The molecular mechanism of action of ivermectin, focusing on Akt/mTOR signaling, was elucidated.Results: Ivermectin arrested growth in the G2/M phase and induced caspase-dependent apoptosis in ovarian cancer, regardless of specific cellular and molecular differences. Ivermectin significantly augmented the inhibitory effect of cisplatin on ovarian cancer cells in a dose-dependent manner. Mechanistically, ivermectin suppressed the phosphorylation of key molecules in the Akt/mTOR signaling pathway in ovarian cancer cells. In addition, overexpression of constitutively active Akt restored ivermectin-induced inhibition of Akt/mTOR, growth arrest and apoptosis. In an ovarian cancer xenograft mouse model, ivermectin alone significantly inhibited tumor growth. In combination with cisplatin, tumor growth was completely reversed over the entire duration of drug treatment without any toxicity. Furthermore, the concentrations of ivermectin used in our study are pharmacologically achievable.Conclusions: Our work suggests that ivermectin may be a useful addition to the treatment armamentarium for ovarian cancer and that targeting Akt/mTOR signaling is a therapeutic strategy to increase chemosensitivity in ovarian cancer.
       
  • Effect of using the rapid shallow breathing index as readiness criterion
           for spontaneous breathing trials in a weaning protocol
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of the Medical SciencesAuthor(s): Juan B. Figueroa-Casas, Ricardo Montoya, Jose Garcia-Blanco, Angelica Lehker, Ahmed M. Hussein, Haider Abdulmunim, Giselle Kabbach, Antonyos Mahfoud BackgroundThis study aimed to compare the effect of using vs. not using the Rapid-Shallow Breathing Index (RSBI) as a readiness criterion for Spontaneous Breathing Trials (SBT) on SBT success.MethodsDaily readiness screens were performed within a respiratory therapist-driven weaning protocol. Patients who passed these screens underwent a one-time measurement of the RSBI and then a SBT regardless of RSBI result. The proportion of passed readiness screens reaching SBT success was compared to the proportion that would have been obtained if RSBI ≤ 105 br/min/L had been used as an additional screen criterion.ResultsTwo hundred and fifty SBTs performed on 157 patients were analyzed. The sensitivity of RSBI ≤ 105 br/min/L to predict SBT success was 94.8% (95% CI 90.6-97.5). Relative to potentially using RSBI, 14.4% additional SBTs were performed. A third of these were successful, and no complications were detected in the rest that failed. The proportion of passed readiness screens reaching SBT success would have been 4% (95% CI 1.2-6.8) (P = 0.002) lower if RSBI had been used.ConclusionsThe inclusion of the RSBI in a readiness screen may not be useful in a weaning protocol.
       
  • Uric acid level as a predictor of long-term mortality in advanced age
           population
    • Abstract: Publication date: Available online 7 November 2019Source: The American Journal of the Medical SciencesAuthor(s): Marwan Abu Sneineh, Yuval Schwartz, Gideon Nesher, Yossi Freier Dror, Gabriel S. Breuer BackgroundHyperuricemia is associated with the development, progression and outcome of several diseases. The purpose of this study is to evaluate the serum uric acid (UA) levels as predictor of long-term mortality in older population (age 60 years and above).MethodsPatients older than 60 years who were hospitalized in the departments of geriatrics and internal medicine in Shaare Zedek Medical Center in Jerusalem during a period of 4 months (March-June 2014) were included in this observational study. Association between hyperuricemia and long-term mortality were analyzed using multiple logistic regression, Kaplan-Meier and Cox proportional hazards regressions analysis.ResultsA total of 624 patients were included in our study with mean age of 77.2 ± 14.6 years. Overall, 381 patients died during the follow up period (61.1%). Mortality rate in the hyperuricemic group (> 7 mg/dl) was higher (69.1%) than in the normo-uricemic group 58.4%. (P = .004). The median survival for hyperuricemic patients was significantly shorter compared to normo-uricemic patients (606 and 1018 days, respectively, P < .0001). High levels of UA were significantly associated with higher long-term mortality in patients with cardiovascular disease at their admission (P < .000).ConclusionsElevated levels of UA in older patients in acute settings is a predictor of long-term mortality.
       
  • Pulmonary Mycobacterium Spindle Cell Pseudotumor in Patient with Liver
           Transplant
    • Abstract: Publication date: Available online 5 November 2019Source: The American Journal of the Medical SciencesAuthor(s): Supavit Chesdachai, Prowpanga Udompap, Faqian Li, John R Lake, Mandip KC We report a case of liver transplant patient who presented with lung masses, found to be Mycobacterium spindle cell pseudotumors. The masses demonstrated hypermetabolic activities on positron emission tomography. Core biopsy revealed sheets of spindle histiocytic cells with abundant acid-fast bacilli identified as Mycobacterium avium-intracellulare complex. This finding is a rare presentation of Mycobacterium infection, mainly non-tuberculous Mycobaterium. It is characterized by a benign, spindle cell mass-forming reaction. Most of the reported cases had acquired immune deficiency syndrome or organ transplant. Histopathology illustrating the proliferation of spindle cell shaped histiocytes containing numerous acid-fast bacilli is the gold standard for diagnosis. The standard treatment has not been well established; previously reported cases followed the standard treatment for Mycobacterium based on organ involvement. Our case is the first case to our knowledge that reports pulmonary Mycobacterium spindle cell pseudotumors in a liver transplant recipient.
       
  • Severe pneumonia advanced to lung abscess and empyema due to Rothia
           mucilaginosa in an immunocompetent patient
    • Abstract: Publication date: Available online 5 November 2019Source: The American Journal of the Medical SciencesAuthor(s): Ling Yang, Ting Liu, Bi-Cui Liu, Chun-Tao Liu
       
  • Differential expression of renin-angiotensin system-related components in
           patients with rheumatoid arthritis and osteoarthritis
    • Abstract: Publication date: Available online 5 November 2019Source: The American Journal of the Medical SciencesAuthor(s): Yuangang Wu, Mingyang Li, Jun Zeng, Zhanzhan Feng, Jing Yang, Bin Shen, Yi Zeng BackgroundThe purpose of this study was to demonstrate the role of renin-angiotensin system (RAS)-related components, vascular endothelial growth factor (VEGF) and atrial metalloproteinase-13 (MMP-13) in synovial tissue and synovial fluid from patients with rheumatoid arthritis (RA) and osteoarthritis (OA).MethodsThirty-four patients with RA and 41 patients with OA were included in the study. Renin, angiotensin-converting enzyme (ACE), VEGF and MMP-13 protein levels in the synovial fluid were measured by enzyme-linked immunosorbent assay (ELISA). qRT-PCR analysis, western blot analysis and immunohistochemistry were used to quantify renin, ACE, angiotensin type 1 and type 2 receptors (AT1R and AT2R), VEGF and MMP-13 in OA and RA. Additionally, the correlation was determined by Pearson's coefficient.ResultsIn synovial fluid, expression levels of renin, ACE, VEGF and MMP-13 in patients with RA were significantly higher than those in patients with OA. In synovial tissue, the RAS components VEGF and MMP-13 were also elevated in patients with RA. The results of immunohistochemistry in synovial tissue also showed that the RAS components VEGF and MMP-13 were significantly increased in patients with RA. Notably, the Pearson coefficient demonstrated that the levels of the RAS components were positively correlated with the expression of VEGF and MMP-13 in OA and RA.ConclusionsThe present results suggest that RAS-related components in RA and OA, including renin, ACE, AT1R and AT2R, are associated with increased expression of VEGF and play an important role in angiogenesis. Furthermore, there was a significant positive correlation between the expression of VEGF and MMP-13.
       
  • Jailed in a bony prison: post-tuberculotic calcific constrictive
           pericarditis
    • Abstract: Publication date: Available online 1 November 2019Source: The American Journal of the Medical SciencesAuthor(s): Georgia Vogiatzi, Konstantinos Aznaouridis, Panagiotis Tolis, Eleftherios Tsiamis, Dimitris Tousoulis
       
  • Pseudotumor of the Lung
    • Abstract: Publication date: Available online 1 November 2019Source: The American Journal of the Medical SciencesAuthor(s): Myung-Won Lee, Hyo Jin Lee
       
  • Hydrogen Studies at ClinicalTrials.gov: The Dawn of a New
           Era'
    • Abstract: Publication date: Available online 28 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Sergej M. Ostojic
       
  • Benign Mediastinal Ectopic Thyroid Mass: An Incidental Finding
    • Abstract: Publication date: November 2019Source: The American Journal of the Medical Sciences, Volume 358, Issue 5Author(s): Ankit Agrawal, Kesavan Sankaramangalam, Talha E. Khan, Divyajot Sadana
       
  • Continuous Glucose Monitoring: Review of an Innovation in Diabetes
           Management
    • Abstract: Publication date: November 2019Source: The American Journal of the Medical Sciences, Volume 358, Issue 5Author(s): Zainab Mian, Kathie L. Hermayer, Alicia Jenkins Most continuous glucose monitors (CGM) provide interstitial fluid glucose trends, which reflect blood glucose trends with alarms and alerts to prevent hypoglycemia and provide better glycemic control. CGM used in conjunction with insulin pumps has changed the management of patients with insulin-dependent diabetes, mainly type 1 diabetes. CGM technology prevents the need for frequent blood glucose testing, which is often cumbersome for patients, providing them with a better alternative. CGM technology is underprescribed and therefore advantage should be taken of this technology to provide better hemoglobin A1c (HbA1c) control and decrease incidence of diabetic complications. CGM is particularly useful in patients with hypoglycemia unawareness and nocturnal hypoglycemia. CGM is currently not approved in pregnant patients, in critically ill patients and patients on dialysis. Research suggests that the benefits certainly outweigh the limitations of this technology. This review article focuses on the technical and clinical use of continuous glucose monitoring and sensor-integrated pump technology.
       
  • DRESS Syndrome and Chronic Renal Failure Induced by Ethambutol
    • Abstract: Publication date: November 2019Source: The American Journal of the Medical Sciences, Volume 358, Issue 5Author(s): El Ghoul Jamel, Sghaier Ahmed
       
  • Risk factors associated with invasive fungal infections in kidney
           transplant patients
    • Abstract: Publication date: Available online 24 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Sara Leitheiser, Andrew Harner, Jennifer L. Waller, Jake Turrentine, Stephanie Baer, Mufaddal Kheda, N. Stanley Nahman, Rhonda E. Colombo BackgroundKidney transplant recipients are at increased risk for developing invasive fungal infections (IFI). We queried the United States Renal Data System (USRDS) for risk factors for IFI in these patients.MethodsPatients who underwent a kidney transplant between 2005-2008 were queried for an IFI diagnosis using ICD-9 codes. An IFI was defined as at least one documented diagnosis from one of the following: 1) Candida (candidemia); 2) histoplasmosis; 3) aspergillosis; 4) cryptococcosis; 5) “Other” mycoses. Potential risk factors included demographics, certain co-morbidities, and immunosuppressive medications. To examine the relative risk (RR), simple bivariate models were used, followed by a comprehensive full model to estimate the adjusted RR (aRR).Results1,218/57,188 kidney transplant patients had 1,343 IFI diagnoses, with a median time to infection of 495 days. "Other" mycoses accounted for the most IFI diagnoses (37%), followed by aspergillosis (22%). The risk for any IFI was increased with age ≥65 years. Diabetes (aRR=1.71), bacterial pneumonia (aRR=1.62), and UTI (aRR=1.34) were the top 3 clinical risk factors for infection. Each of the IFI groups were also associated with individual risk factors. Therapy with mycophenolate mofetil was associated with a decreased risk of candidemia.ConclusionRisk factors for IFI in renal transplant patients include demographic, medication-associated, and clinical data, as well as organism-specific factors. These results offer an extensive clinical profile of risk for IFI, and may thus help inform the diagnosis and presumptive therapy of invasive fungal infections in renal transplant recipients.
       
  • Girolamo Fabrici d'Acquapendente and the Oplomochlion: the several
           applications of an effective rehabilitation tool
    • Abstract: Publication date: Available online 24 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Carlo Biz, Alessandro Brunati, Elisa Belluzzi, Pietro Ruggieri, Stefano Masiero, Maurizio Rippa Bonati Girolamo Fabrici d'Acquapendente (1533-1619) was an Italian anatomist, surgeon and physiologist and a protagonist of the scientific revolution of the Renaissance. He made anatomy a scientific discipline and is justly considered a precursor of modern orthopaedics. He invented and used several external corrective devices for the treatment of congenital and acquired deformities of the limbs and spinal column, especially those following tubercular infection and rickets, torticollis, vertebral caries kyphosis, scoliosis, and rachitic deformities of the leg, but also congenital dislocation of the hip and congenital club-foot. He ascribed the pathogenesis of the equinovarus supinated foot to the position taken by the foot of the fetus during intrauterine life. The Oplomochlion, shown in the Operationes chirurgicae and attributed to Fabrici, is actually a collection of very diverse orthotic, prosthetic and surgical metal instruments invented by Fabrici and arranged with a demonstrative purpose and a topographic criterion, as if on an exhibition dummy.
       
  • SSCI Presidential Symposium Presented at the SRM in 2019: HIV- mediated
           tissue injury in the era of anti-retroviral therapy
    • Abstract: Publication date: Available online 23 October 2019Source: The American Journal of the Medical SciencesAuthor(s): David M. Guidot, Jeffrey R. Pine
       
  • SYMPOSIUM ARTICLE: HIV and the kidney: From HIV-associated nephropathy to
           reservoir
    • Abstract: Publication date: Available online 23 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Mary Klotman
       
  • 2019 SSCI Presidential Symposium Lung and kidney disease in people living
           with HIV: Section 1: HIV-related Lung Disease
    • Abstract: Publication date: Available online 23 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Sushma K. Cribbs
       
  • The prognostic value of endotoxemia and intestinal barrier biomarker ZO-1
           in bacteremic sepsis
    • Abstract: Publication date: Available online 22 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Stelios F. Assimakopoulos, Karolina Akinosoglou, Anne-Lise de Lastic, Aikaterini Skintzi, Athanasia Mouzaki, Charalambos A. GogosABSTRACTBackgroundIntestinal barrier dysfunction exerts a pivotal pathophysiological role in the development of multiple organ dysfunction in sepsis. The present study was undertaken to investigate the potential role of serum intestinal fatty acid-binding protein (I-FABP) and zonula occludens-1 (ZO-1) levels as biomarkers of intestinal barrier dysfunction in bacteremic sepsis.MethodsSeventy-five patients with bacteremic sepsis of abdominal origin (n = 34) or non-abdominal origin (n = 41) and 12 healthy controls were retrospectively studied. Blood samples collected upon sepsis diagnosis were analysed for serum ZO-1, I-FABP and endotoxin levels. Prognostic scores Sequential Organ Failure Assessment (SOFA), quickSOFA and Acute Physiology and Chronic Health Evaluation (APACHE-II) were determined over the first 24 hours after sepsis diagnosis and patients’ outcome in terms of 28-day mortality was recorded.ResultsSerum ZO-1 levels were significantly higher in bacteremic septic patients as compared to controls with no difference between patients with abdominal or extra-abdominal source of infection. Serum I-FABP levels were significantly lower in septic patients as compared to control and this reduction was more evident in patients with bacteremic abdominal sepsis. Serum ZO-1 and endotoxin concentrations were found significantly higher in patients who did not survive from sepsis. In receiver operating characteristic curve analysis, both endotoxin and ZO-1 predicted 28-day mortality. In addition, ZO-1 and endotoxin were correlated with the prognostic scores of qSOFA, SOFA and APACHE II.ConclusionsThe results of this study indicate that serum ZO-1 might be a reliable biomarker of gut barrier dysfunction in sepsis, not affected by the abdominal or extra-abdominal site of infection. ZO-1, measured early at sepsis diagnosis, might represent a valuable additional prognostic tool for patients’ outcome.
       
  • The potential protective effects of diosmin on streptozotocin-induced
           diabetic cardiomyopathy in rats
    • Abstract: Publication date: Available online 22 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Tarek Mohamed Ali, Osama M. Abo-Salem, Basem Hassan El Esawy, Ahmed El Askary BackgroundDiabetic cardiomyopathy (DCM) is a non-ischemic myocardial disorder characterized by metabolic disturbances and oxidative stress in diabetic patients. The present paper aims to determine the protective effect of the phlebotrophic drug, diosmin, on DCM in a model of high-fat diet-fed and streptozotocin-induced type 2 diabetes in the rat.Materials and MethodsThe animals were divided into 4 groups (8 rats/group) as follows: vehicle-treated non-diabetic control group, vehicle-treated diabetic group, diosmin (50 mg/kg)-treated diabetic group and diosmin (100 mg/kg)-treated diabetic group. Treatment was given once daily orally by gavage for 6 weeks. Oxidant and anti-oxidant stress markers, inflammatory markers and pro-apoptotic and anti-apoptotic gene expression using quantified real-time polymerase chain reaction were investigated.ResultsDiosmin treatment in diabetic rats lowered elevated blood glucose levels, homeostatic model assessment for insulin resistance, cardiac creatine kinase and lactate dehydrogenase enzymes, cardiac malondialdehyde and nitric oxide. Moreover, diosmin increased plasma insulin and c-peptide levels, cardiac glutathione content, superoxide dismutase, catalase, and glutathione S-transferase activities. Also, diosmin treatment significantly (P < 0.05) lowered the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), down-regulated cardiac Bcl-2-associated X protein and caspase 3 and 9 and up-regulated B-cell lymphoma 2 mRNA expression levels.ConclusionsDiosmin may have a sizeable therapeutic potential in the treatment of DCM due to antidiabetic, antioxidative stress, anti-inflammatory, and anti-apoptotic effects. Detailed studies are needed to disclose the precise mechanisms motivating the protective effect of diosmin‏.
       
  • HIV- mediated tissue injury in the era of anti-retroviral therapy
    • Abstract: Publication date: Available online 22 October 2019Source: The American Journal of the Medical SciencesAuthor(s): David M. Guidot
       
  • Acknowledgment of Reviewers
    • Abstract: Publication date: Available online 18 October 2019Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Relation of decreased circulating sortilin levels with unfavorable
           metabolic profiles in subjects with newly diagnosed type 2 diabetes
           mellitus
    • Abstract: Publication date: Available online 17 October 2019Source: The American Journal of the Medical SciencesAuthor(s): İsmail DEMIR, Ozden YILDIRIM AKAN, Aslı GULER, Giray BOZKAYA, Behnaz ASLANIPOUR, Mehmet CALANABSTRACTBackgroundSortilin, a pluripotent peptide hormone, plays a role in glucose and lipid metabolism. A link between sortilin and insulin sensitivity has been implicated. However, the clinical implications of this link remain elusive. Our aims were to investigate whether sortilin levels were altered in subjects with newly diagnosed type 2 diabetes mellitus (nT2DM) compared with subjects with normal glucose tolerance (NGT) and to determine whether a link exists between sortilin levels and metabolic parameters.Materials and MethodsA total of 150 subjects including 75 nT2DM patients and 75 subjects with NGT who were matched in age, body mass index, and gender were enrolled into this case-control study. The circulating levels of sortilin were measured using enzyme-linked immunosorbent assay. A 2-hour 75-g oral glucose tolerance test was used for diagnosis of T2DM. Metabolic parameters of enrolled subjects were also determined.ResultsThe circulating levels of sortilin were found to be significantly lower in subjects with nT2DM than in controls (138.44 ± 38.39 vs. 184.93 ± 49.67 pg/mL, P < 0.001). Sortilin levels showed a negative correlation with insulin resistance and unfavorable lipid profiles, while they were positively correlated with high-density lipoprotein cholesterol in subjects with nT2DM. Linear regression analysis showed an independent and inverse link between sortilin and insulin resistance and unfavorable lipid profiles. Moreover, logistic regression analysis revealed that the subjects with the lowest sortilin levels had an increased risk of nT2DM compared with those subjects with the highest sortilin levels.ConclusionsDecreased circulating levels of sortilin were associated with unfavorable metabolic profiles in subjects with nT2DM.
       
  • Biventricular Pulsus Alternans: “Stolen Pulses” seen by
           Echocardiography in Pulmonary Hypertension
    • Abstract: Publication date: Available online 3 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Yu Kang, Liuyu Yu, Qing Zhang
       
  • Cardiogenic Pulmonary Edema
    • Abstract: Publication date: Available online 1 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Logan Dobbe, Rubayat Rahman, Mohamed Elmassry, Pablo Paz, Kenneth Nugent The initial events in cardiogenic pulmonary edema involve hemodynamic pulmonary congestion with high capillary pressures. This causes increased fluid transfer out of capillaries into the interstitium and alveolar spaces. High capillary pressures can also cause barrier disruption which increases permeability and fluid transfer into the interstitium and alveoli. Fluid in alveoli alters surfactant function and increases surface tension. This can lead to more edema formation and to atelectasis with impaired gas exchange. Patients with barrier disruption have increased levels of surfactant protein B in the circulation, and these levels often remain high after the initial clinical improvement. Routine clinical assessment may not identify patients with increased extravascular fluid in the lungs; pulmonary ultrasound can easily detect pulmonary edema in patients with acute decompensation and in patients at risk for decompensation. Studies using serial pulmonary ultrasound could help characterize patients with cardiogenic pulmonary edema and help identify subgroups who need alternative management. The conventional management of cardiogenic pulmonary edema usually involves diuresis, afterload reduction, and in some cases non-invasive ventilation to reduce the work of breathing and improve oxygenation. Patients with persistent symptoms, abnormal chest x-rays, and diuretic resistance might benefit from alternative approaches to management. These could include beta agonists and pentoxifylline which warrant more study in patients with cardiogenic pulmonary edema.
       
  • Evaluation of efficacy and safety for lentinan in the control of the
           malignant pleural effusions via intrapleural injection
    • Abstract: Publication date: Available online 1 October 2019Source: The American Journal of the Medical SciencesAuthor(s): Qi Congcong, Zhu Hengting, Li Shuhui, Yuan Fang, Wang Shan BackgroundMany studies have investigated the efficacy and safety of lentinan combined with cisplatin versus cisplatin alone for controlling malignant pleural effusion (MPE). This study is a meta-analysis of available evidence.MethodsSeventeen studies reporting lentinan combined with cisplatin versus cisplatin alone for controlling MPE were reviewed. Pooled odds ratios and hazard ratio with 95% confidence intervals were calculated using the fixed effects model of meta-analysis.ResultsThe overall response rate (ORR) of lentinan combined with cisplatin for controlling MPE was significantly higher than that of cisplatin alone (P 
       
  • Evolutionary Medicine of Retroviruses in the Human Genome
    • Abstract: Publication date: Available online 30 September 2019Source: The American Journal of the Medical SciencesAuthor(s): Yukako Katsura, Satoshi Asai Humans are infected with many viruses, and the immune system mostly removes viruses and the infected cells. However, certain viruses have entered the human genome. Of the human genome, ∼45% is composed of transposable elements (LINE, SINE and transposons) and 5-8% is derived from viral sequences with similarity to infectious retroviruses. If integration of retrovirus occurs in a germline, the integrated viral sequences are heritable. Accumulation of viral sequences has created the current human genome. This article summarizes recent studies of retroviruses in humans and bridges clinical fields and evolutionary genetics. First, we report the repertories of human-infective retroviruses. Second, we review endogenous retroviruses in the human genome and diseases associated with endogenous retroviruses. Third, we discuss biological functions of endogenous retroviruses and propose the concept of accelerated human evolution via viruses. Finally, we present perspectives of virology in the field of evolutionary medicine.
       
  • In Memoriam John Alexander Oates, III
    • Abstract: Publication date: Available online 28 September 2019Source: The American Journal of the Medical SciencesAuthor(s): Jim Oates
       
  • Gut microbial metabolite trimethylamine N-oxide (TMAO) is related to
           thrombus formation in atrial fibrillation patients
    • Abstract: Publication date: Available online 19 September 2019Source: The American Journal of the Medical SciencesAuthor(s): Dingxu Gong, Lin Zhang, Ying Zhang, Fang Wang, Zhenwen Zhao, Xianliang ZhouABSTRACTBackgroundAtrial fibrillation (AF) is the most prevalent cardiac arrhythmia. Patients with AF are prone to forming cardiac thrombi. Elevated serum trimethylamine N-oxide (TMAO) levels are associated with increased thrombosis risk. No previous studies have examined the relationship between serum TMAO levels and thrombus formation in AF patients.MethodsA total of 117 consecutive rheumatic heart disease patients with AF were enrolled. The patients were divided into two groups: patients with thrombi (n = 25) and patients without thrombi (n = 92). Platelet function tests were performed by light transmittance aggregometry. Serum TMAO, betaine, and choline levels were quantified by liquid chromatography combined with tandem mass spectrometry. Results were compared between the two groups. The correlation between serum TMAO levels and thrombi formation was examined.ResultsNo remarkable differences in demographic characteristics were found between the two groups. Serum TMAO levels were significantly higher in the thrombus group (4.55 UM [3.19–4.83] versus 3.53 UM [2.96–4.25], P = 0.01). Enhanced platelet hyperreactivity was more likely in the thrombus group. ROC analysis showed the diagnostic potential of serum TMAO levels to identify thrombus formation, with an area under the curve of 0.661 (P = 0.01, 95% CI: 0.52–0.80). Binary regression analyses showed that serum TMAO had potent predictive power for thrombus formation (P < 0.01, CI: 95%).ConclusionsElevated serum TMAO levels were predictive of thrombus formation in AF patients. Our results highlight the usefulness of serum TMAO levels in identifying individuals with increased susceptibility to thrombus formation, allowing development of precise thrombus prevention strategies.
       
  • Chronic, silent microaspiration masquerading as interstitial lung disease
    • Abstract: Publication date: Available online 18 September 2019Source: The American Journal of the Medical SciencesAuthor(s): Biplab K. Saha, Aditi Saha, Llewellyn A. Foulke, Scott Beegle Chronic, silent microaspiration is a common but underrecognized pathologic process in pulmonary medicine. The clinical presentation is variable and diagnosis can be challenging. We present the case of a 55-year-old woman with known emphysema, who was referred to us for progressive respiratory failure that was unresponsive to therapy. The patient had nine hospital admissions in the preceding five months and was treated with multiple courses of antibiotics and systemic steroid therapy for a diagnosis of cryptogenic organizing pneumonia. The steroid therapy was complicated by 51 pounds of weight gain. She had conversational as well as profound exertional shortness of breath. Physical examination revealed a woman in moderate distress and bilateral diffuse wheezing and rhonchi. Computed tomography of the chest revealed areas of bronchocentric consolidation and bronchial wall thickening in the bilateral lower lobes. She underwent surgical lung biopsy and the histopathology was consistent with chronic aspiration pneumonia.
       
  • Systemic Tuberculosis Mimicking Lung Cancer with Multiple Metastases
    • Abstract: Publication date: Available online 18 September 2019Source: The American Journal of the Medical SciencesAuthor(s): Chou-Chin Lan, Chih-Wei Wu, Yao-Kuang Wu
       
  • Janus Kinase 2 mutation associated Budd-Chiari syndrome presenting as a
           tumor
    • Abstract: Publication date: Available online 17 September 2019Source: The American Journal of the Medical SciencesAuthor(s): Cheng-Mao Shen, Wei-Chou Chang, Hsuan-Hwai Lin
       
  • Risks of Prescription Sharing
    • Abstract: Publication date: Available online 17 September 2019Source: The American Journal of the Medical SciencesAuthor(s): Amara Sarwal, Vidya Menon, Isaiarasi Gnanasekaran
       
  • The Natural History of Iron Deficiency Anemia
    • Abstract: Publication date: Available online 31 August 2019Source: The American Journal of the Medical SciencesAuthor(s): Samuel Dickey, Don C. Rockey BackgroundCurrent evidence suggests that adult men and non-menstruating women with iron deficiency anemia (IDA) should undergo gastrointestinal (GI) evaluation to detect a potential bleeding lesion. We hypothesized that after endoscopic evaluation and treatment, IDA would be expected to resolve. Thus, we aimed to understand the natural history of IDA, in particular long-term outcomes.MethodsAdult patients with IDA (defined as anemia and ferritin
       
  • Update on diabetes technology: Are we ready to move beyond capillary
           glucose testing and insulin injections'
    • Abstract: Publication date: Available online 30 August 2019Source: The American Journal of the Medical SciencesAuthor(s): Rodolfo J. Galindo, Alexandra L. Migdal, Guillermo E. Umpierrez
       
  • Insulin Pumps: Review of Technological Advancement in Diabetes Management
    • Abstract: Publication date: Available online 28 August 2019Source: The American Journal of the Medical SciencesAuthor(s): Nicoleta D. Sora, Fnu Shashpal, Elizabeth A. Bond, Alicia J. Jenkins Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII) therapy is an evolving form of insulin delivery which has been shown to be highly effective in maintaining euglycemia and providing patients with flexibility in their lives. It functions by providing the patient with a continuous subcutaneous infusion of a rapid acting insulin and allows the patient to administer boluses throughout the day for food and correction of high glucose levels. CSII is approved in patients with type 1 diabetes and selected patients with type 2 diabetes; however, it is important to select the right patients for pump therapy. Insulin pump technology continues to rapidly evolve, and many options are now on the market, including those that are used in conjunction with continuous glucose monitoring. This review article focuses on the pros and cons of CSII therapy as well as the technical and clinical considerations in starting a patient on this therapy.
       
  • Why Did the United States Medical School Admissions Quota for Jews
           End'
    • Abstract: Publication date: Available online 26 August 2019Source: The American Journal of the Medical SciencesAuthor(s): Edward C. Halperin At the end of World War II anti-Semitism was pervasive in the United States. Quotas to limit the number of Jewish students were put in place at most U.S. medical schools in the 1920s and were well-entrenched by 1945. By 1970 the quota was gone. Why'Multiple factors contributed to the end of the quota. First, attitudes towards Jews shifted as Americans recoiled from the horrors of the Holocaust and over half a million Jewish GIs returned home from World War II. Many entered the higher education system.Second, governmental and private investigations in New York City, New York State, and Philadelphia exposed the quota. Third, New York State, led by Governor Thomas E. Dewey, established four publicly supported non-discriminatory medical schools. These schools adsorbed many New York Jewish applicants. Fourth, from the 1920’s through the 1960’s some medical schools consistently or intermittently ignored the quota. Finally, the federal and several state governments passed non-discrimination in higher education legislation.The quotas ended because of a combination of changing societal attitudes and government and private social action. This remarkable social change may be instructive as higher education now grapples with allegations of a quota system for Asian-Americans.
       
  • Mapping the Mutation Landscape of Colorectal Cancer
    • Abstract: Publication date: Available online 14 August 2019Source: The American Journal of the Medical SciencesAuthor(s): Kimberly J. Newsom, Petr Starostik
       
  • Beware energy drinks: A case of a toxic triad syndrome in a diabetic
           patient with non-alcoholic fatty disease
    • Abstract: Publication date: Available online 2 August 2019Source: The American Journal of the Medical SciencesAuthor(s): Gabriel I. Uwaifo Energy drinks are widely used and very popular. They are touted as “harmless” energy boosters for use in professional, recreational and domestic settings. They are typically high in monosaccharides, and caffeine with other assorted products like ginseng. Careful study of the potential risks of their use are nonexistent while rigorous documentation of their touted energy boosting capacity is also meagre. We present the cautionary case of a 46-year-old Caucasian man with well controlled type 2 diabetes and non alcoholic fatty liver disease who developed a toxic triad syndrome of gastritis, hepatitis and pancreatitis within 4 months of commencing daily consumption of 2-3 160z cans of the energy drink Monster Energy. His clinical symptoms and biochemical derangements promptly resolved with stopping the beverage. We discuss the potential risks inherent in unsupervised liberal consumption of energy drinks and the need for both caution and vigilance among clinicians and patients.
       
  • Influenza with community-associated methicillin-resistant
           Staphylococcus aureus pneumonia
    • Abstract: Publication date: Available online 1 August 2019Source: The American Journal of the Medical SciencesAuthor(s): Chia-Wei Liu, Shih-Ping Lin, Wei-Yao Wang, Yen-Hsiang Huang Patients with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia had poor clinical outcomes and high frequency of mortality, especially in patents with post-influenza infection. Herein, we report a case of community-acquired pneumonia (CAP) with multiple organ failure in a 51-year-old patient with initial presentation of flu-like symptoms. The influenza rapid test from the specimen of nasopharyngeal swab was positive for type B influenza virus, and was confirmed by real-time polymerase chain reaction. Gram stain of bronchoalveolar lavage fluid revealed gram positive cocci in group. Both sputum and blood culture yielded MRSA. We identified the CA-MRSA was staphylococcal cassette chromosome mec type IV strain carried Panton–Valentine leukocidin gene. The patient made a complete recovery following an 8-week treatment course of linezolid, and was discharged with independent daily activity. According to our experience, linezolid may be a reasonable treatment choice for CA-MRSA pneumonia due to the virulence of exotoxins.
       
  • Discovery of aberrant alteration of genome in colorectal cancer by exome
           sequencing
    • Abstract: Publication date: Available online 1 August 2019Source: The American Journal of the Medical SciencesAuthor(s): Yuanzi Liang, Liejun Jiang, Xiaogang Zhong, Steven N. Hochwald, Yongsi Wang, Lihe Huang, Qiumiao Nie, Huayi Huang, Jun-Fa Xu BackgroundThis study analyzed multiple parameters including somatic single nucleotide variations (SNVs), InDels, significantly mutated genes (SMGs), copy number variations (CNVs), and frequently altered pathways aims to discover novel aberrances in the tumorigenesis of colorectal cancer (CRC).MethodsExome sequencing was performed on an Illumina platform to identify novel potential somatic variances in 34 paired tumor and adjacent normal tissues from 17 CRC patients. Results were compared with databases (dbSNP138, 1000 genomes SNP, Hapmap, COSMIC and ESP6500) and analyzed. MuSic software was used to identify SMGs.ResultsIn total, 1637 somatic SNVs in 17 analyzed tumors were identified. Only 7 SNVs were shared by more than 1 tumor, suggesting that over 99% of the analyzed SNVs were independent events. Mutation of KRAS p. G12D and ZNF717 p. L39V were the most common SNVs. Moreover, 10 SMGs namely KRAS, TP53, SMAD4, ZNF717, FBXW7, APC, ZNF493, CDR1, ARMC4 and SUMF2 were found. Among those, ZNF717, ZNF493, CDR1, ARMC4, and SUMF2 were novel frequent genes in CRC. For CNVs analysis, gains in 10q25.3, 1p31.1, 1q44, 10q23.33, 11p15.4, and 20q13.33, and loss of 3q21.3 and 3q29 were frequent aberrations identified in our results.ConclusionsWe frequently found novel genes ZNF717, ZNF493, CDR1, ARMC4, and SUMF2 and gains in 10q25.3, which may be functional mutation in CRC. The high frequency private events such as SNVs confirms the highly heterogeneous mutations found in CRCs. The mutated genes sites in different patients may vary significantly, which may also be more challenging for clinical treatment.
       
  • Association between IL-6 polymorphisms and diabetic nephropathy risk: a
           meta-analysis
    • Abstract: Publication date: Available online 31 July 2019Source: The American Journal of the Medical SciencesAuthor(s): Bin Chen, Meiyan Wu, Chongsen Zang, Yanhua Li, Zhonggao Xu BackgroundThe objective of this work was to evaluate the relevance of frequent IL-6 polymorphisms and diabetic nephropathy (DN) susceptibility by a systematic meta-analysis.MethodsThe included studies related to the relationship between IL-6 and DN risk were searched from Pubmed, Embase, and the Cochrane Library, and the Newcastle-Ottawa Scale was used to evaluate the study quality. A heterogeneity test was performed to determine the appropriate effect models based on the Q test and I2 statistic. Odds ratios with 95% confidence intervals were employed for determine the strength of associations. Afterwards, subgroup analysis was conducted to assess the effect of specific factors on the corresponding results. Additionally, publication bias and sensitivity analysis were also undertaken.ResultsIn total, 11 eligible articles were obtained. The meta-analysis revealed that the“C”allele of IL-6 rs1800795 was related to the decreased risk of DN (C vs. G: P = 0.0471). The“G”allele of IL-6 rs1800796 was predominately associated with higher DN risks (GG vs. CC: P = 0.0194; GG vs. CC+GC: P = 0.0196). The“C”allele of IL-6 rs1800797 was implicated with higher prevalence of DN (C vs. G: P = 0.0001; CC vs.GG: P = 0.0003; CC vs. GG+CG: P = 0.0227; CC+CG vs. GG: P = 0.0001) while IL-6 rs2069837 and rs2069840 were not correlated with the susceptibility to DN.ConclusionsThis meta-analysis indicated that IL-6 rs1800795, rs1800796 and rs1800797 played important roles in DN development while IL-6 rs2069837 and rs2069840 might not be related to DN.
       
  • Impact of Atrial Fibrillation on In-Hospital Outcomes in Patients with
           Diabetic Ketoacidosis
    • Abstract: Publication date: Available online 27 July 2019Source: The American Journal of the Medical SciencesAuthor(s): Yifeng Yang, Baoqiong Liu, Jiabei He, Sonali Gupta, Soumya Thumma, Yiming Luo, George Everett, Joseph Mattana BackgroundDiabetic ketoacidosis entails a huge health burden among patients with diabetes. Atrial fibrillation (AF) is the most common type of heart arrhythmia. This study aimed to evaluate the impact of atrial fibrillation on clinical outcomes in patients with diabetic ketoacidosis.MethodsUsing the 2012-2014 National Inpatient Sample database (NIS), we identified adult patients hospitalized with diabetic ketoacidosis as the principal discharge diagnosis. The identified admissions were stratified into two cohorts based on the atrial fibrillation presence. We used multivariable regression models and propensity score matching models to evaluate in-hospital mortality, length of stay, comorbidities, and in-hospital complications.ResultsThe study included 478,890 adult patients who were admitted for diabetic ketoacidosis in the year 2012-2014. A total of 467,780 (97.68%) had no atrial fibrillation and 11,125 (2.32%) had atrial fibrillation. In both multivariable regression models and propensity score matching models, compared with non-atrial fibrillation group, the atrial fibrillation group had higher in-hospital mortality rates (2.36[1.69-3.32], P < 0.001) and longer length of stay (5.5 vs 3.3 days, P < 0.001). Atrial fibrillation was also associated with a significantly higher incidence of complications including septic shock, pulmonary failure, mechanical ventilation, neurological failure, cerebral edema, acute kidney injury, acute hematologic failure, and cardiac arrest.ConclusionsAmong patients who were hospitalized for diabetic ketoacidosis, comorbid atrial fibrillation led to increasing in-hospital mortality rates and longer length of stay. A potential explanation was that atrial fibrillation increased the risk of in-hospital complications including respiratory failure with a more frequent requirement for mechanical ventilation, cardiac arrest, and metabolic encephalopathy.
       
  • IL-33/ST2 signaling promotes hepatocellular carcinoma cell stemness
           expansion through activating JNK pathway
    • Abstract: Publication date: Available online 24 July 2019Source: The American Journal of the Medical SciencesAuthor(s): Rongrong Zhao, Zeyuan Yu, Min Li, Yongning ZhouABSTRACTBackgroundInterleukin-33 (IL-33) has a variety of biological activities in different pathological models. However, the underlying effects of IL-33 on hepatocellular carcinoma (HCC) have not been fully elucidated. Therefore, we focused on investigating the biological effects of IL-33 on HCC stemness expansion.MethodsIL-33 expression in clinical tissue specimens were evaluated using immunohistochemical technology. Western blotting, flow cytometry and quantitative real-time polymerase chain reaction (PCR) were used to detect protein expressions in HCC cell lines. ST2 expression was downregulated by utilizing the synthetic siRNA sequence that specifically targets ST2. The transfection of ST2 siRNAs and control siRNAs into HCC cells was performed with Lipofectamine RNAi MAX (Life Technologies) according to the manufacturer's protocol.ResultsOur results demonstrated that IL-33 is expressed both in cancer cells and stromal cells of the HCC microenvironment, and that IL-33 expression in cancer cells, but not in stromal cells, was negatively associated with survival of HCC patients. IL-33 promotes HCC stemness expansion, including upregulating core stem cell gene expression, inducing cell sphere formation and preventing chemotherapy-induced apoptosis in vitro. Mechanistically, IL-33 binds to its receptor ST2 and induces phosphorylation of c-Jun N-terminal kinase activation (JNK), which leads to HCC stemness expansion.ConclusionsIL-33/ST2 signaling might be potential prognosis markers and therapeutic targets for HCC patients.
       
  • Dyspnea in Patients with Stiff-Person Syndrome
    • Abstract: Publication date: Available online 18 July 2019Source: The American Journal of the Medical SciencesAuthor(s): William Sexauer, Matthew Woodford, Katrina Pack, Anthony Allen, Albert Crawford, Goran RakocevicABSTRACTBackgroundStiff-person syndrome (SPS) is a rare autoimmune disorder that leads to progressively worsening stiffness and spasm of thoracic and proximal-limb musculature. Dyspnea has been reported but not analyzed in patients with SPS.MethodsFor this prospective study, 17 patients were recruited from a university-based neurology clinic. History and exam were performed, demographic information collected, available imaging reviewed. Dyspnea was assessed using vertical Visual Analog scales (VAS), the University of California San Diego Shortness of Breath Questionnaire (UCSD-SOBQ), and dyspnea “descriptors”. Standardized assessments of SPS severity were performed by an experienced neurologist. Forced vital capacity (FVC) spirometric analysis was performed on all patients.ResultsFifteen of 17 patients complained of dyspnea, including dyspnea at rest, with exertion, and disturbing sleep. A restrictive pattern was the most common abnormality noted on spirometry. FVC (r = -0.67; P < 0.01) and forced expiratory volume in 1-second (FEV1) (r = -0.76; P < 0.01) percent predicted correlated with dyspnea measured by VAS over the preceding 2 weeks. Pulmonary function did not correlate with UCSB-SOBQ or standardized measures of SPS severity.ConclusionsDyspnea in SPS is common and occurs at rest, with exertion, and disturbs sleep. The finding of restrictive physiology and correlation between pulmonary function variables and dyspnea support the hypothesis that thoracic cage constriction by rigidity and/or spasm of the muscles of the trunk causes or contributes to the sensation of dyspnea. The possibility of diaphragmatic involvement requires further study.
       
  • The value of plasma-based microRNAs as diagnostic biomarkers for ovarian
           cancer
    • Abstract: Publication date: Available online 17 July 2019Source: The American Journal of the Medical SciencesAuthor(s): Weiwei Wang, Yin Yin, Xia Shan, Xin Zhou, Ping Liu, Quan Cao, Danxia Zhu, JinYing Zhang, Wei Zhu BackgroundOvarian cancer (OC) is one of the most threatening diseases among women in the world. Plasma microRNAs (miRNAs) may serve as promising diagnostic biomarkers for patients with OC.MethodsUsing quantitative reverse transcription polymerase chain reaction (qRT-PCR) based on Exiqon panel, we identified 27 differentially expressed miRNAs from 2 OC pool samples and 1 normal control (NC) pool in the initial screening phase. Then we further validated the identified miRNAs through the training (32 OC VS. 34 NCs) and validation stages (69 OC VS. 66 NCs) using qRT-PCR. The expression levels of the miRNAs were also assessed in tissues and exosomes.ResultsFive plasma miRNAs (miR-205-5p, miR-145-5p, miR-10a-5p, miR-346, and miR-328-3p) were significantly overexpressed in OC in comparison with NCs. The areas under the receiver operating characteristic curve of the 5-miRNA panel were 0.788 for the training stage and 0.763 for the validation stage. The level of miR-205-5p has significantly different expression in patients with well–moderate histological grade compared with those with a poor grade (P = 0.012). The expression levels of the 5 miRNAs were also significantly upregulated in the exosomes of OC plasma samples (32 OC vs. 32 NCs). However, the expression of the 4 miRNAs (miR-145-5p, miR-10a-5p, miR-346, and miR-328-3p) was significantly lower in tumor samples than in normal tissues (22 OC vs. 22 NCs).ConclusionsThe 5 plasma miRNAs may be noninvasive diagnostic biomarkers of OC. The plasma miR-205-5p level may reflect the change trend of the histological grade of OC patients.
       
  • Call a Spade a Spade: Missed Diagnosis of Apical Hypertrophic
           Cardiomyopathy
    • Abstract: Publication date: Available online 13 July 2019Source: The American Journal of the Medical SciencesAuthor(s): Davis Leaphart, Ashley Waring, Pal Suranyi, Valerian FernandesABSTRACTApical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy characterized by apical hypertrophy, deep T-wave inversions in precordial electrocardiogram (EKG) leads, and a ventriculogram shaped like the ‘Ace of Spades’. Patients are often asymptomatic but sometimes present with atypical chest pain, angina, or atrial fibrillation. The deep T-wave inversions on EKG often mimic acute coronary syndrome. Coronary angiogram in these patients is unrevealing, but the characteristic left ventriculogram establishes this diagnosis. The deep T-wave inversions can appear suddenly or deepen over years, making the diagnosis difficult to establish early in the disease. Transthoracic echocardiogram may miss the hypertrophied apex, but echo contrast imaging or cardiac magnetic resonance imaging (MRI) can reliably confirm the diagnosis and detect apical aneurysms. We present a case of apical hypertrophic cardiomyopathy which was not evident despite many admissions, EKGs, cardiac catheterizations, and echocardiograms until the diagnosis was confirmed with left ventriculogram and cardiac MRI 20 years after initial presentation.
       
  • Gouty Tophi Manifesting as a Pancreatic Foci
    • Abstract: Publication date: Available online 13 July 2019Source: The American Journal of the Medical SciencesAuthor(s): Shreesh Shrestha, Faisal Kamal, Muhammad Ali Khan, Claudio R. Tombazzi Gout is a common disorder of uric acid metabolism highly prevalent in our population. The majority of the patients with gout present with acute monoarticular arthritis but, a significant proportion of patients also go on to develop chronic tophaceous gout. Musculoskeletal sites are the usual sites of tophus formation and, very rarely, tophi may form in a visceral organ. We present a case of pancreatic gout of which only 3 cases have been reported. Our case is unique and challenging, as it initially masqueraded a pancreatic neoplasm creating many diagnostic dilemmas.
       
  • Magnetic Resonance Imaging Findings of Intrapulmonary Hematoma
    • Abstract: Publication date: Available online 25 May 2019Source: The American Journal of the Medical SciencesAuthor(s): Hiroshi Wada, Takuto Sakashita, Akitoshi Inoue
       
  • Late PCI in patients with ST-segment elevation myocardial infarction with
           prolonged ischemic symptoms beyond the 12 hour window: The importance of
           knowing the presence of multi-vessel coronary artery disease
    • Abstract: Publication date: Available online 23 May 2019Source: The American Journal of the Medical SciencesAuthor(s): Osmar Antonio Centurión
       
  • Penetrating Aortic Ulcer Masquerading as Acute Coronary Syndrome
    • Abstract: Publication date: Available online 7 May 2019Source: The American Journal of the Medical SciencesAuthor(s): Ajay Kumar Mishra, Srinivas Nadadur, Kamal Kant Sahu, Amos Lal
       
  • Treatment windows and clinical outcomes in late-presenting patients with
           ST-segment elevation myocardial infarction
    • Abstract: Publication date: Available online 7 May 2019Source: The American Journal of the Medical SciencesAuthor(s): Ming Gao, Ling Qin, Zhiguo Zhang, Liping Chen, Yang Zheng, Qian Tong, Quan Liu BackgroundPercutaneous coronary intervention (PCI) is the reperfusion strategy typically used in patients with ST-segment elevation myocardial infarction (STEMI) who present with prolonged ischemic symptoms (>12 hours after onset). However, there is no consensus on an optimal time window for PCI. We examined a real-world cohort, assessing time from symptom onset to balloon inflation in relation to long-term nonfatal recurrent myocardial infarction (MI) or all-cause mortality.MethodsA total of 825 consecutive patients presenting with ischemic symptoms of STEMI>12 hours after symptom onset and undergoing subsequent primary PCI were grouped by time-to-treatment status (≤7 days or>7 days post-MI). Primary endpoints were nonfatal recurrent MI and all-cause mortality.ResultsCumulative rates of recurrent nonfatal MI at 2 years were 4.1% and 3.3% in patients with symptom-onset-to-balloon inflation times of ≤7 days and>7 days, respectively (P = 0.049); and corresponding mortality rates were 3.4% and 4.7% (P = 0.238). In Cox multivariate analyses, syndrome-onset-to-balloon-inflation time was not independently predictive of recurrent MI (P = 0.052) or mortality (P = 0.651) at 2 years, once adjusted for certain clinical and angiographic variables known to influence patient outcomes. The 2-year rate of recurrent MI was highest in patients with multi-vessel coronary artery diseases undergoing primary PCI ≤7 days after symptom onset to balloon inflation (P = 0.005).ConclusionsIn patients presenting with ischemic signs or symptoms of STEMI>12 hours after initial symptom onset and treated by PCI, symptom-onset-to-balloon-inflation times ≤7 days showed no relation to nonfatal recurrent MI, unless in the presence of multi-vessel coronary artery diseases.
       
 
 
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