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Publisher: Elsevier   (Total: 3161 journals)

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Showing 1 - 200 of 3161 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 33, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 23, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 94, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 34, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 411, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 249, 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: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, 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: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 16, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 147, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, 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: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, 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: 31, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 8, 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: 3)
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: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, 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: 29, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, 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: 11)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 24)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 28, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 44, 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: 56, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 16, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, 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: 8, 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: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
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: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, 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: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 9)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
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: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (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: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 397, 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: 10, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
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: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 47, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 341, 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: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 446, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, 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: 2)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, 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: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 50, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 54, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 28, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 46)
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: 205, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, 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: 27, 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: 38, 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: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 17, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
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: 43, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 177, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 11, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, 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: 189, SJR: 1.58, CiteScore: 3)

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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  [3161 journals]
  • Metformin Associated with Improved Outcomes in Diabetic Patients with
           Laryngeal and Oropharyngeal Carcinoma
    • Abstract: Publication date: Available online 13 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Amie Ogunsakin, Jordan Infield, Jeffery Zuber, Solomon S. Solomon
       
  • Acute Pancreatitis due to a rare ductal anomaly: ansa pancreatica
    • Abstract: Publication date: Available online 13 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Houssem Harbi, Nozha Toumi, Mohamed Ben Amar
       
  • The Dust Bowl in the US: An Analysis Based on Current Environmental and
           Clinical Studies
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Robert Alexander, Connie Nugent, Kenneth NugentAbstractThe Dust Bowl occurred in the Central Plains states in the United States between 1930 and 1940. Prolonged drought, intense recurrent dust storms and economic depression had profound effects on human welfare. The causes included increased farming on marginal land, poor land management, and prolonged drought. There was a significant increase in the number of cases of measles, increased hospitalization for respiratory disorders and increased infant and overall mortality in Kansas during the Dust Bowl. Recent scientific studies have demonstrated that dust transmits measles virus, influenza virus and Coccidioides immitis, and that mortality in the United States increases following dust storms with 2-3-day lag periods. Advances in technology have provided information about the composition of dust and the transfer of microbial pathogens in dust and provided the framework for reducing the economic and health consequences of the next prolonged drought in the United States.
       
  • Central Retinal Artery Occlusion Following Hyaluronic Acid Fillers
           Injection
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Ji-Long Hao, Om Prakash Pant, Cheng-Wei Lu
       
  • The American Journal of the Medical Sciences Editorial Office
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s):
       
  • Kallmann Syndrome With Micropenis
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Chia-Po Fu, I-Te Lee
       
  • Recurrent Severe Hypoinsulinemic Hypoglycemia Responsive to Temozolomide
           and Bevacizumab in a Patient With Doege-Potter Syndrome
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Amie A. Ogunsakin, Holly L. Hilsenbeck, David C. Portnoy, Ebenezer A. NyenweAbstractNonislet cell tumor hypoglycemia is rare. We highlight the diagnosis and treatment of recurrent severe hypoglycemia in a 49-year-old woman with malignant solitary fibrous tumor of the pleura (Doege-Potter syndrome). The clinical, laboratory and radiologic findings of the case are presented and a brief literature review is provided. Of note, imaging studies showed a large mass in the right hemithorax and pathology and immunehistochemical stains confirmed a malignant solitary fibrous tumor of the pleura. She was a poor surgical candidate owing to a large tumor burden. She was treated with a combination of temozolomide and bevacizumab to which she responded with resolution of hypoglycemia. The treatment of choice for hypoglycemia in patients with the Doege-Potter syndrome is surgical excision. We here report that a combination of temozolomide and bevacizumab may be a viable option in patients with inoperable disease.
       
  • Evaluation and Management of Gross Hematuria in Autosomal Dominant
           Polycystic Kidney Disease: A Point of Care Guide for Practicing Internists
           
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Bhavna Bhasin, Mohammed Alzubaidi, Juan Carlos Q. VelezAbstractGross hematuria is common in autosomal dominant polycystic kidney disease (ADPKD). It is an alarming symptom and may be the first manifestation of ADPKD. Cyst hemorrhage is a frequent cause of hematuria in ADPKD while other differential diagnoses include cyst infection, urinary tract infection, renal stones and an underlying malignancy. Knowledge of the precipitating factors and clinical presentation of these conditions will help practicing internists in performing an appropriate evaluation and management of these entities and their complications, as well as executing timely referrals to subspecialists when indicated.
       
  • Silent Information Regulator 1 Negatively Regulates Atherosclerotic
           Angiogenesis via Mammalian Target of Rapamycin Complex 1 Signaling Pathway
           
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Runtai Chen, Zhenchun Huang, Junyi Wang, Xiaoying Chen, Yucai Fu, Wei WangAbstractBackgroundThis study aimed to investigate the interactions between silent information regulator 1 (SIRT1) and mammalian target of rapamycin (mTOR) in intraplaque angiogenesis and their potential mechanisms through in vivo and in vitro studies.MethodsAn atherosclerosis model was established in 12 rabbits on a high-cholesterol diet. The rabbits were equally divided into 3 groups: a control group (high-lipid diet), RAP group (high-lipid diet supplemented with rapamycin) and RAP + NAM group (high-lipid diet supplemented with rapamycin and nicotinamide). At the end of 4 weeks, the area of plaques in the aorta was determined and the protein expression of CD31 and vascular endothelial growth factor (VEGF) was detected through hematoxylin and eosin staining and immunohistochemical staining, respectively. For in vitro study, a hypoxia model was established in human umbilical vein endothelial cells (HUVECs) by using the chemical method (CoCl2). The MTT assay, scratch assay and tube formation assay were performed to evaluate the proliferation and angiogenesis abilities of HUVECs. Reverse transcription polymerase chain reaction was used to examine the mRNA levels of SIRT1, hypoxia-inducible factor-1α (HIF-1α), mTOR and p70 ribosomal S6 kinase (p70S6K). Western blotting was used to examine the protein levels of SIRT1, HIF-1α, mTOR, p-mTOR, p-raptor and p-p70S6K.ResultsThe results of the in vivo study indicated a significant inhibitory effect of rapamycin on plaque size and intraplaque angiogenesis (0.05 ± 0.02 mm2 versus 5.44 ± 0.50 mm2, P < 0.05). This effect was attenuated by nicotinamide (0.76 ± 0.15 mm2 versus 0.05 ± 0.02 mm2, P < 0.05). Compared with the RAP group, CD31- and VEGF-positive vessels were abundant in the RAP + NAM group. The RAP group showed lower expression of p-mTOR, p-p70S6K and HIF-1α than did the control group (P < 0.05), whereas the RAP + NAM group showed slightly higher expression of these factors than did the RAP group (P < 0.05). Furthermore, in vitro studies revealed that the inhibitory effect of rapamycin on the angiogenic ability of HUVECs and its significant inhibitory effects on the protein level of HIF-1α and the phosphorylation of proteins involved in the mTORC1 pathway, including mTOR, raptor and p70S6K (P < 0.05), were enhanced by cotreatment with SRT1720 and rapamycin (P < 0.05). In contrast to mTOR and SIRT1, the mRNA levels of p70S6K and HIF-1α were reduced by rapamycin (P < 0.05) and further reduced by cotreatment with SRT1720 and rapamycin.ConclusionsThe study results indicate that SIRT1 might negatively regulate atherosclerotic angiogenesis via mTORC1 and HIF-1α signaling pathway and cointervention of SIRT1 and mTOR may serve as a crucial therapeutic strategy in cardiovascular medicine.
       
  • Gender-Specific Association of Leptin and Adiponectin Genes With Multiple
           Sclerosis
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Marziyeh Yousefian, Reza Nemati, Gholamreza Daryabor, Naser Gholijani, Alireza Nikseresht, Afshin Borhani-Haghighi, Eskandar Kamali-SarvestaniAbstractBackgroundAdipocytokines such as leptin (LEP) and adiponectin (ADIPOQ) represent a link between metabolism, nutritional status and immune responses. The present study aimed to determine the possible association between single nucleotide polymorphisms of LEP and ADIPOQ genes with multiple sclerosis (MS).Materials and methodsSingle nucleotide polymorphisms in LEP (rs2167270 or 19G> A and rs7799039 or −2,548G> A) and ADIPOQ (rs1501299 or +276G> T and rs266729 or −11,377C> G) were genotyped in 305 patients and 255 healthy individuals using polymerase chain reaction-restriction fragment length polymorphism. Sera levels of leptin and adiponectin were measured using enzyme-linked immunosorbent assay.ResultsThe frequencies of low leptin producer rs2167270GG genotype and rs2167270G allele were significantly lower in patients with MS compared to those of controls (for GG genotype: 39.7% and 49.8%, respectively; P = 0.01; for G allele: 63.3% and 68.8%, respectively; P = 0.05). Both polymorphisms in ADIPOQ did not show any significant association with disease susceptibility, though after gender categorization the frequency of high adiponectin producer rs1501299TT genotype and rs1501299T allele were significantly higher in male controls compared to male patients (TT genotype: P = 0.006; T allele: P = 0.006). Additionally, rs1501299TT genotype in ADIPOQ was associated with susceptibility to primary progressive multiple sclerosis (PP-MS) (P = 0.02). Moreover, while the sera levels of leptin were only different between male patients and controls (P = 0.05), adiponectin levels were significantly higher in total and female healthy controls (P < 0.001, P = 0.002, respectively).ConclusionsOur findings provide evidence to support the hypothesis that functional ADIPOQ and LEP gene polymorphisms are associated with susceptibility to MS and its clinical forms.
       
  • Postthrombotic Syndrome: Long-Term Sequela of Deep Venous Thrombosis
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Abdelmoniem Moustafa, Hussam Mohammad Alim, Mohammed Andaleeb Chowdhury, Ehab A. EltahawyAbstractPostthrombotic syndrome is a common long-term complication of proximal lower extremity deep venous thrombosis, which not only significantly affects the quality of life of patients but also imposes a substantial financial burden on our healthcare system. Due to limited awareness and inability of physicians to recognize and treat this condition early, its prevalence is steadily increasing. In this article, we review the pathophysiology, the risk factors involved, diagnostic workup, and the various management options available to treat this condition.
       
  • Modifiable Predictors of In-Hospital Mortality in Patients Undergoing
           Transcatheter Aortic Valve Replacement
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Oluwaseun A. Akinseye, Muhammad Shahreyar, Chioma C. Nwagbara, Mannu Nayyar, Salem A. Salem, Mohamed Morsy, Rami N. Khouzam, Uzoma N. IbebuoguAbstractBackgroundTranscatheter aortic valve replacement (TAVR) has become an acceptable therapy for patients with severe aortic valve stenosis at high or prohibitive surgical risk. Attempts are ongoing to validate risk prediction models for in-hospital mortality after TAVR. Our aim was to define modifiable risk factors predictive of in-hospital mortality after TAVR.MethodsWe identified patients who underwent TAVR from the 2012 database of the National Inpatient Sample. Patients who died during the index hospitalization were compared to those that were successfully discharged. The predictors of in-hospital mortality were analyzed using multivariate logistic regression.ResultsA total of 1,360 patients (mean age 81 ± 8.8 years, whites 80.1%, blacks 3.5%) had TAVR and 68 (5%) died during hospitalization (χ2 [1, n = 1,360] = 1,101.6, P < 0.001). The average length of hospital stay was 8.33 ± 6.7 days. The positive predictors of in-hospital mortality in the unadjusted model were comorbidities such as congestive heart failure, coagulopathy, fluid and electrolyte disorder, weight loss and history of drug abuse. Hypertension was a negative predictor of in-hospital mortality. Following multivariate analysis and adjustment for possible confounders, fluid and electrolyte disorder was the only significant positive predictor of in-hospital mortality (odds ratio = 1.89, CI: 1.11-3.22, P = 0.019). The odds of in-hospital mortality were reduced in patients with hypertension (odds ratio = 0.45, CI: 0.26-0.78, P = 0.004).ConclusionsFluid and electrolyte disturbance could be a modifiable predictor of in-hospital mortality following TAVR. Efforts should be geared towards reducing its occurrence in this patient population.
       
  • Correlations of Circulating Cell-Free DNA With Clinical Manifestations in
           Acute Myocardial Infarction
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Jin Xie, Jiawei Yang, Pei HuAbstractBackgroundThe objective of the study was to examine the potential use of circulating cell free DNA (cfDNA) in acute myocardial infarction (AMI) patients and correlate it with clinical features. Serial monitoring was conducted to assess any associations to disease.MethodsQuantification of cfDNA was performed on 130 cardiovascular disease (CVD) patients as well as 30 healthy volunteers. Serial samplings were conducted using PicoGreen dsDNA assay. Of the 130 patients with CVD, 100 had an AMI and measurements were taken during treatment. Short and medium intervals serial sampling of patients’ blood were undertaken.ResultsThe results were highly correlative of CVD disease status. The mean concentration of cfDNA in patients with AMI was 5 folds higher during the onset of disease compared with healthy volunteers. The cfDNA content was also higher than other patients with CVD. Interestingly, short term monitoring of patients with AMI showed distinct trends that highlighted the severity of the disease and linked to complication events. Medium term monitoring showed 2 distinctive groups with 1 that had their cfDNA returned to basal levels and the other with persistently elevated cfDNA levels.ConclusionsMeasuring cfDNA in patients with CVD offers an alternative approach to monitor the disease and has potential clinical applications to identify high-risk individuals.
       
  • Coding and Noncoding Variants in CFH Act Synergistically for Complement
           Activation in Immunoglobulin A Nephropathy
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Wei-yi Guo, Qing-zhen Liu, Li Zhu, Zeng-yan Li, Si-Jun Meng, Su-fang Shi, Li-Jun Liu, Ji-Cheng Lv, Ping Hou, Hong ZhangAbstractBackgroundIn immunoglobulin A nephropathy (IgAN), complement activation occurs in both the systemic circulation and in situ (glomerular). A recent IgAN-genome-wide association study (GWAS) identified 1q32 as an IgAN susceptible locus that contained the complement regulatory protein coding gene complement factor H (CFH). Here, we explored the combined genetic effects of coding and noncoding variants in CFH, rs6677604 and rs800292 on complement activation in IgAN.MethodsIn total, 1,194 IgAN patients and 900 healthy controls who were the same as the Beijing Discovery Cohort in our recent IgAN-GWAS were recruited. The genotyping information of rs800292 and rs6677604 were extracted from GWAS data, while the information regarding plasma C3 levels and mesangial C3 deposits were collected from medical records.ResultsWe found both rs800292-GG and rs6677604-GG were risk genotypes for complement activation in IgAN patients, as represented by lower plasma C3 levels in IgAN patients with rs800292-GG and a higher intensity of glomerular C3 deposits in those with rs6677604-GG, respectively. Additionally, IgAN patients with 2 risk genotypes (rs800292-GG and rs6677604-GG) showed a higher degree of complement activation compared to those with no risk genotypes (rs800292-AA/AG and rs6677604-AA/AG), as represented by both lower plasma C3 levels and a higher intensity of glomerular C3 deposits. Moreover, when compared to rs800292 or rs6677604 alone, the combined genetic effects of rs800292 and rs6677604 showed a stronger association with IgAN susceptibility.ConclusionsOur findings suggested that both coding and noncoding variants in CFH acted synergistically to regulate the degree of complement activation and thereby contributed to IgAN susceptibility.
       
  • Congenital Absence of Left Coronary Artery Accompanied by Premature
           Ventricular Complexes
    • Abstract: Publication date: Available online 1 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Hong-Feng Jin, Xiao-Wei Liu, Chang-Qing Du
       
  • BRCA2 Loss-of-Function and High Sensitivity to Cisplatin-Based
           Chemotherapy in a Patient With a Pleomorphic Soft Tissue Sarcoma: Effect
           of Genomic Medicine
    • Abstract: Publication date: Available online 1 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Camille Tlemsani, Eric Pasmant, Pascaline Boudou-Rouquette, Audrey Bellesoeur, Julien Even, Frédérique Larousserie, Cécile Reyes, David Gentien, Jérôme Alexandre, Michel Vidaud, Philippe Anract, Karen Leroy, François GoldwasserAbstractWe report the case of a patient with a BRCA2 germline mutation who developed a localized pleomorphic soft tissue sarcoma of the leg with poor prognostic features. BRCA2 germline mutations were not previously reported to be associated with pleomorphic sarcoma. BRCA2 loss-of-heterozygosity was found in the tumor, resulting in a complete BRCA2 loss-of-function. BRCA2 deficiency is associated with sensitivity to cisplatin-based chemotherapy in breast and ovarian cancer patients. We used a cisplatin-based chemotherapy. A rapid major partial response was obtained, which allowed a curative and conservative surgical resection of the sarcoma followed by adjuvant irradiation. This case illustrates that sarcoma patients may present unexpected but targetable genetic abnormalities and that BRCA2 loss-of-function may be targetable in sarcoma as it is associated with enhanced sensitivity to cisplatin. Our observation emphasizes the input of genomic medicine in clinical practice, its importance for treatment decisions, and the overlap between constitutional and somatic genetics.
       
  • Clopidogrel Partially Counteracts Adenosine-5′-Diphosphate Effects on
           Blood Pressure and Renal Hemodynamics and Excretion in Rats
    • Abstract: Publication date: Available online 27 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Malwina Monika Roszkowska-Chojecka, Agnieszka Walkowska, Janusz Sadowski, Leszek DobrowolskiAbstractBackgroundAdenosine-5′-diphosphate (ADP) can influence intrarenal vascular tone and tubular transport, partly through activation of purine P2Y12 receptors (P2Y12-R), but their actual in vivo role in regulation of renal circulation and excretion remains unclear.MethodsThe effects of intravenous ADP infusions of 2-8 mg/kg/hour were examined in anesthetized Wistar rats that were untreated or chronically pretreated with clopidogrel, 20 mg/kg/24 hours, a selective P2Y12-R antagonist. Renal blood flow (transonic probe) and perfusion of the superficial cortex and medulla (laser-Doppler fluxes) were measured, together with urine osmolality (Uosm), diuresis (V), total solute (UosmV), sodium (UNaV) and potassium (UKV) excretion.ResultsADP induced a gradual, dose-dependent 15% decrease of mean arterial pressure, a sustained increase of renal blood flow and a 25% decrease in renal vascular resistance. Clopidogrel pretreatment attenuated the mean arterial pressure decrease, and did not significantly alter renal blood flow or renal vascular resistance. Renal medullary perfusion was not affected by ADP whereas Uosm decreased from 1,080 ± 125 to 685 ± 75 mosmol/kg H20. There were also substantial significant decreases in UosmV, UNaV and UKV; all these changes were attenuated or abolished by clopidogrel pretreatment. Two-weeks’ clopidogrel treatment decreased V while UosmUosmV and UNaV increased, most distinctly after 7 days. Acute clopidogrel infusion modestly decreased mean arterial pressure and significantly increased outer- and decreased inner-medullary perfusion.ConclusionsOur functional studies show that ADP can cause systemic and renal vasodilation and a decrease in mean arterial pressure, an action at least partly mediated by P2Y12 receptors. We confirmed that these receptors exert tonic action to reduce tubular water reabsorption and urine concentration.
       
  • The Beat Goes On: The Story of 5 Ageless Cardiac Drugs
    • Abstract: Publication date: Available online 25 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Harold SmulyanAbstractThis article traces the history of 5 cardiac drugs—Aspirin, Atropine, Digitalis, Nitroglycerine, and Quinidine—that have been in continuous use for centuries and some for longer. Four of the 5 started life as botanicals and 4 have as also served widely varied functions far removed from their current purposes. Collectively, they have played a role in the history of royalty, religious leaders, assassinations and military campaigns in addition to their place in medical therapy. Their present clinical status has evolved from long-term clinical observation without the need for controlled clinical trials, detailed statistical analyses or FDA approvals. This review of their background illustrates the varied means by which markedly different substances from widely separated sources can come together to participate in the management of circulatory disorders.
       
  • Clinical Efficacy of Serum-Derived Bovine Immunoglobulin in Patients with
           Refractory Inflammatory Bowel Disease
    • Abstract: Publication date: Available online 5 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Hammad Liaquat, Munish Ashat, Abigail Stocker, Lindsay McElmurray, Karen Beatty, Thomas L. Abell, Gerald DrydenAbstractBackgroundInflammatory bowel disease (IBD) can have autoimmunity and/or intestinal barrier dysfunction as part of pathophysiology and may be refractory to all available treatment options. Serum-derived bovine immunoglobulin/protein isolate (SBI) binds microbial components with postulated downstream effects of normalized gut immune and barrier function which may be useful for managing IBD. The purpose of our study was to evaluate the effectiveness of SBI in the management of refractory IBD, particularly symptoms of chronic diarrhea and loose stools.MethodsWe retrospectively analyzed charts for patients diagnosed with IBD (n = 40) who were refractory to standard treatment. Patients received oral SBI 5 gram daily for a period of at least 6 weeks. Twelve patients with IBD fulfilled study inclusion criteria. Each patient graded the severity and frequency of gastrointestinal symptoms before starting SBI and at 6 weeks of treatment using a standardized patient assessment form. Means and standard deviations for all symptom scores at baseline and week 6 of treatment were analyzed.ResultsMean symptom scores decreased significantly for nausea (P = 0.02 for severity and P = 0.03 for mean symptom score) and diarrhea (P = 0.0006, P = 0.0001 and P = 0.0001 for severity, frequency and mean symptom score, respectively).ConclusionTherapy with SBI alleviated some refractory gastrointestinal symptoms in patients with IBD, including nausea and diarrhea. Increased duration, dosage and/or frequency of SBI might provide additional symptom improvement and could be tested through controlled clinical trials with larger sample sizes and longer follow up.
       
  • Current Evidence in Delivery and Therapeutic Uses of Fecal Microbiota
           Transplantation in Human Diseases – Clostridium difficle disease and
           beyond
    • Abstract: Publication date: Available online 5 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Joshua Stripling, Martin Rodriguez
       
  • The Properties of Cytokine in Multiple Sclerosis: Pros and Cons
    • Abstract: Publication date: Available online 5 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Kexin Wang, Feng Song, Alejandro Fernandez-Escobar, Gang Luo, Jun-hui Wang, Yu SunAbstractMultiple sclerosis is a chronic autoimmune disease that affects the central nervous system and is characterized by demyelination, axonal loss, gliosis, and inflammation. The last plays a major role in the onset and propagation of the disease. Multiple sclerosis presents with heterogeneous lesions containing a broad range of cells and soluble mediators of the immune system such as T cells, B cells, macrophages, microglia, cytokines, chemokines, antibodies, complement, and other toxic substances. This review outlines, analyzes, and discusses the different immune mechanisms of MS that are responsible for the initiation and propagation of active lesions, demyelination, axonal injury, remyelination, and cell loss as well as the role of cytokines in the disease process. Pro-inflammatory cytokines such as Interleukin-17 (IL-17), IL-22, tumor necrosis factor-α, IL-1, IL-12, and interferon-γ may cause multiple sclerosis through several signaling pathways. Conversely, anti-inflammatory circulating cytokines such as IL-4 and IL-10 are reduced and theoretically can exert a direct protective effect in this condition. Future studies are necessary to develop effective, safe, and long-lasting strategies to reduce the abnormal cytokine cascades and to treat multiple sclerosis.
       
  • The Birth of Angiotensin: An International Compromise
    • Abstract: Publication date: Available online 4 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Harold Smulyan, Daniel VillarrealAbstractIrvine Page in the United States and Eduardo Braun-Menéndez in Argentina led teams of investigators that studied the role of the kidney in blood pressure regulation. Contemporaneously in 1939, each team using different methods discovered and described a new substance now known as angiotensin. At the time of discovery, Page called it “angiotonin” and Braun-Menéndez called it “hipertensina”, anglicized to “hypertensin”. Over time, the importance of this substance in circulatory control, pathophysiology and pharmacology became indisputable and the need for a single name became obvious. In a remarkable accommodation, Page and Braun-Menéndez agreed to forego any claim to priority and chose a name with elements of both. Following this compromise, Page and Braun-Menéndez went on to become leaders in science in their own countries as well as recognition world-wide while angiotensin and its derivatives have become standard components in the understanding and treatment of diseases of the heart, kidney and brain.
       
  • Lupus and Cardiovascular Disease
    • Abstract: Publication date: Available online 31 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Jan Nilsson
       
  • The use of microbiome restoration therapeutics to eliminate intestinal
           colonization with multidrug-resistant organisms
    • Abstract: Publication date: Available online 29 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Srinivasa Nithin Gopalsamy, Michael H. Woodworth, Tiffany Wang, Cynthia T. Carpentieri, Nirja Mehta, Rachel J. Friedman-Moraco, Aneesh K. Mehta, Christian P. Larsen, Colleen S. KraftAbstractAntibiotic resistance (AR) has been described by the World Health Organization as an increasingly serious threat to global public health. Many mechanisms of AR have become widespread due to global selective pressures such as widespread antibiotic use. The intestinal tract is an important reservoir for many multidrug-resistant organisms (MDROs) and next-generation sequencing has expanded understanding of the resistome, defined as the comprehensive sum of genetic determinants of AR. Intestinal decolonization has been explored as a strategy to eradicate MDROs with selective digestive tract decontamination and probiotics being notable examples with mixed results. This review focuses on fecal microbiota transplantation (FMT) and the early evidence supporting its efficacy in decolonizing MDROs and potential mechanisms of action to reduce AR genes. Current evidence suggests FMT may have promise in restoring healthy microbial diversity and reducing AR, and clinical trials are underway to better characterize its safety and efficacy.
       
  • Correlations of microRNA-21 Gene Polymorphisms with Chemosensitivity and
           Prognosis of Cervical Cancer
    • Abstract: Publication date: Available online 29 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Jing Zhang, Yan-Hua Li, Hong-Li Liu, Yuan Zhang, Qing-Song Zhang, Sheng-Ze LiAbstractBackgroundWe investigated correlations of miR-21 gene polymorphisms including rs1292037 (A> G) and rs13137 (A> T) with the chemosensitivity to cisplatin plus paclitaxel, and prognosis before cervical cancer (CC) surgery, which may provide a novel target for prevention and treatment of CC.MethodsA total of 165 patients with CC were divided into 2 groups, a sensitive group and resistance group. Gene polymorphisms of rs1292037 (A> G) and rs13137 (A> T) were detected respectively. Logistic and Cox multivariate regression analyses were used to explore factors that influence resistance to cisplatin plus paclitaxel.Resultsrs1292037 (A> G) locus AG, GG, AG + GG and G allele in miR-21 gene may increase chemoresistance to cisplatin plus paclitaxel in CC. The risk factors of prognosis included rs1292037 (A> G) locus, tumor stage, maximum lesion diameter and LNM (hazard ratio [HR] = 1.819, 95% CI = 1.127-2.935; HR = 1.504, 95% CI = 1.070-2.114; HR = 1.671, 95% CI = 1.038-2.689; HR = 3.043, 95% CI = 1.783-5.193). The influencing factors of resistance to cisplatin plus paclitaxel included maximum lesion diameter, tumor stage, lymph node metastasis (LNM) and rs1292037 (odds ratio [OR] = 14.047, 95% CI = 5.694-34.653; OR = 5.873, 95% CI = 3.104-11.110; OR = 3.574, 95% CI = 1.554-8.216; OR = 2.449, 95% CI = 1.052-5.705).Conclusionrs1292037 (A> G) locus are associated with the chemoresistance to cisplatin plus paclitaxel and prognosis of patients with CC. In addition to that, the G allele at rs1292037 (A> G) locus increases the risk of preoperative chemoresistance to cisplatin plus paclitaxel and is a poor prognostic factor for patients with CC.
       
  • IgG4-related pleuritis without tuberculous pleurisy
    • Abstract: Publication date: Available online 28 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Toshiyuki Kita
       
  • We Care About Patient-Reported Outcomes, But We Don't Communicate with our
           Patients
    • Abstract: Publication date: Available online 27 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Devika Nair
       
  • Putting the CAP on ICU admissions: Can clinical prediction tools help
           determine appropriate site of care'
    • Abstract: Publication date: Available online 22 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Frances Mae West, Bharat K. Awsare
       
  • Ewing's sarcoma/peripheral primitive neuroectodermal tumors in bronchus
    • Abstract: Publication date: Available online 22 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Jun Chen, Tao Yuan, Xiao Liu, Bei Hua, Chenfeng Dong, Yawu Liu, Guanmin QuanAbstractEwing sarcoma/peripheral primitive neuroectodermal tumors (ES/pPNET), a member of the Ewing sarcoma family of tumors, is a malignant soft tissue tumor with small undifferentiated neuroectodermal cells. Primary trachea-bronchial ES/pPNET is very rare. The most common pulmonary ES is due to a metastasis. We describe a case of ES/pPNET which originated in the left basal trunk bronchus. The patient was a 30-year-old male, presenting with irritable cough and fever for 10 days. A tumor of 60 mm in diameter was found in the left basal trunk bronchus, extending to the left lower lobe. No distant metastases were detected. Histopathological examination revealed a malignancy of ES/pPNET with a diffuse proliferation of round cells, a Flexner-Wintersteiner rosette formation and positive staining for CD99. The patient was successfully treated with a combination of left lower lobectomy and adjuvant chemotherapy and has remained disease-free for approximately 18 months at follow-up. This case highlights that ES/pPNET should be considered as a differential diagnosis in cases of trachea-bronchial tumors.
       
  • Study of The Microbiome has Reached Prime Time
    • Abstract: Publication date: Available online 22 August 2018Source: The American Journal of the Medical SciencesAuthor(s): C. Mel Wilcox
       
  • A patient-centered approach to care in chronic disease
    • Abstract: Publication date: Available online 21 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Jeffrey J. Swigris
       
  • DEVELOPMENT OF THE PEDIATRIC GUT MICROBIOME: IMPACT ON HEALTH AND DISEASE
    • Abstract: Publication date: Available online 21 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Faith D. Ihekweazu, James VersalovicABSTRACTThe intestinal microbiota are important in proper human growth and development before and after birth, during infancy and childhood. Microbial composition may yield insights into the temporal development of microbial communities and vulnerabilities to disorders of microbial ecology such as recurrent Clostridium difficile infection. Discoveries of key microbiome features of carbohydrate and amino acid metabolism are lending new insights into possible new therapies or preventative strategies for inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). In this review, we summarize the current understanding of the development of the pediatric gastrointestinal microbiome, the influence of the microbiome on the developing brain through the gut-brain axis, and the impact of dysbiosis on the development of disease. Microbial dysbiosis will be explored in the context of pediatric allergy and asthma, recurrent C. difficile infection, IBD, IBS, and metabolic disorders. The central premise is that the human intestinal microbiome plays a vital role throughout human life beginning in the prenatal period and extending throughout childhood in health and disease.
       
  • Priority for treatment and intensive care of patients with non-severe
           community-acquired pneumonia
    • Abstract: Publication date: Available online 7 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Hai-yan Li, Qi Guo, Wei-dong Song, Yi-ping Zhou, Ming Li, Xiao-ke Chen, Hui Liu, Hong-lin Peng, Hai-qiong Yu, Xia Chen, Nian Liu, Zhong-dong Lü, Li-hua Liang, Qing-zhou Zhao, Mei JiangAbstractBackgroundThe Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is unclear whether the patients with non-severe CAP meeting the minor criteria most strongly associated to mortality should have the priority for treatment and intensive care. It is warranted to explore this intriguing hypothesis.MethodsA retrospective cohort study of 1230 patients with CAP was performed. This was tested against a prospective 2-center cohort of 1749 adults with CAP.ResultsThe patients with CAP fulfilling the predictive findings most strongly associated to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality rates than those not fulfilling the predictive findings in subgroup analyses of the retrospective cohort. The more the number of predictive findings present, the higher the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly, the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly higher mortality rates compared with the patients with severe CAP not meeting the predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort. Two similar and intriguing paradigms about sequential organ failure assessment (SOFA) scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts.ConclusionsThe patients with non-severe CAP fulfilling the predictive findings most strongly associated to mortality demonstrated higher SOFA and PSI scores and mortality rates, and might have the priority for treatment and intensive care.
       
  • Broadening the differential diagnosis of IgG4-related pleuritis
    • Abstract: Publication date: Available online 6 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Oscar M.P. Jolobe
       
  • Honiton laces in oral cavity
    • Abstract: Publication date: Available online 1 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Shelly Arora, Ranjeet Ajit Bapat, Tanay Chaubal
       
  • Mitigation of stroke risk in nonvalvular atrial fibrillation patients with
           high grade carotid artery stenosis
    • Abstract: Publication date: Available online 1 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Oscar M P Jolobe
       
  • Risk Factors for Low Pharmacy Refill Adherence among Older Hypertensive
           Men and Women by Race
    • Abstract: Publication date: Available online 29 July 2018Source: The American Journal of the Medical SciencesAuthor(s): LaKeisha G. Williams, Erin Peacock, Cara Joyce, Lydia A. Bazzano, Daniel Sarpong, Paul K. Whelton, Elizabeth W. Holt, Richard Re, Edward Frohlich, Jiang He, Paul Muntner, Marie Krousel-WoodAbstractBackgroundSex-race stratification may lead to identification of risk factors for low antihypertensive medication adherence that are not apparent when assessing risk factors in women and men without race stratification. We examined risk factors associated with low pharmacy refill adherence across sex-race subgroups (white women, black women, white men, black men) within the Cohort Study of Medication Adherence among Older Adults (n=2,122).MethodsPharmacy refill adherence was calculated as proportion of days covered (PDC) using all antihypertensive prescriptions filled in the year prior to a baseline risk factor survey. Sex- and sex-race-stratified multivariable Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios and 95% confidence intervals for associations between participant characteristics and low adherence.ResultsPrevalence of low adherence was 22.9% versus 40.7% in white versus black women (p
       
  • Association Between Aldehyde Dehydrogenase 2 Glu504Lys Polymorphism and
           Alcoholic Liver Disease
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Binxia Chang, Shuli Hao, Longyu Zhang, Miaomiao Gao, Ying Sun, Ang Huang, Guangju Teng, Baosen Li, David W. Crabb, Praveen Kusumanchi, Li Wang, Suthat Liangpunsakul, Zhengsheng ZouAbstractBackgroundOnly a subset of patients with excessive alcohol use develop alcoholic liver disease (ALD), though the exact mechanism is not completely understood. Once ingested, alcohol is metabolized by 2 key oxidative enzymes, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). There are 2 major ALDH isoforms, cytosolic and mitochondrial, encoded by the aldehyde ALDH1 and ALDH2 genes, respectively. The ALDH2 gene was hypothesized to alter genetic susceptibility to alcohol dependence and alcohol-induced liver diseases. The aim of this study is to determine the association between aldehyde dehydrogenase 2 (rs671) glu504lys polymorphism and ALD.MethodsALDH2 genotyping was performed in 535 healthy controls and 281 patients with ALD.ResultsThe prevalence of the common form of the single nucleotide polymorphism rs671, 504glu (glu/glu) was significantly higher in patients with ALD (95.4%) compared to that of controls (73.7%, P < 0.0001). Among controls, 23.7% had the heterozygous (glu/lys) genotype compared to 4.6% in those with ALD (odds ratio [OR] = 0.16, 95% CI: 0.09-0.28). The allele frequency for 504lys allele in patients with ALD was 2.3%, compared to 14.5% in healthy controls (OR = 0.13, 95% CI: 0.07-0.24).ConclusionsPatients with ALDH2 504lys variant were less associated with ALD compared to those with ALDH2 504glu using both genotypic and allelic analyses.
       
  • Fatal Hepatotoxicity Due to Viaminate
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Hui Zhang, Ji Zhang, Hongmei DongAbstractViaminate is a derivative of retinoic acid (tretinoin) used in the treatment of severe acne and other disorders of keratinization. Liver dysfunction due to viaminate therapy has not been well described and there have been no reported deaths due to viaminate-induced hepatotoxicity. Herein, we report the case of a woman who underwent treatment at the hospital for 38 days and died of hepatic failure after taking viaminate for more than 2 months. This case provides further insight into viaminate-induced hepatotoxicity.
       
  • Diagnosis and Management of Solitary Laryngeal Neurofibromas
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Lili Zhang, Juan Jiang, Chengping Hu, Huaping Yang, Pengbo Deng, Yuanyuan LiAbstractSolitary laryngeal neurofibromas are exceedingly rare with only 14 cases reported in the previous literature. Herein, we reported a case of solitary laryngeal neurofibroma and reviewed all the published cases of this disease on the clinical manifestations and management options. Patients with solitary laryngeal neurofibromas can present with a variety of respiratory symptoms. Immunohistochemical examination of tumor specimen is critical for pathologic diagnosis and complete surgical resection is the optimal therapy. Endoscopic microsurgeries followed by CO2 laser management of the surgical border may be effective on preventing recurrence. Depending on the location, size and invasiveness of the lesions, the management and prognosis vary among patients. Long-term follow-up is highlighted owing to the possibility of recurrence during a long period of time after surgery.
       
  • Pseudomelanosis Duodeni in the Setting of Chronic Hydralazine Use
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Marcus A. Toschi, George A. Salem, Mohammad Madhoun
       
  • TMPRSS2-ERG Fusion Promotes Recruitment of Regulatory T cells and Tumor
           Growth in Prostate Cancer
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Lei Shan, Tongyu Ji, Xiang Su, Qichao Shao, Tao Du, Shilong ZhangAbstractBackgroundThis study was designed to examine the effect of transmembrane protease serine 2 ETS-related gene (TMPRSS2-ERG) fusion on regulatory T cells and tumor growth in prostate cancer, which may provide a new potential therapeutic direction for PCa.MethodsThe effect of TMPRSS2-ERG fusion on the migration of Treg cells and tumor growth in a mouse model was investigated in vitro and in vivo. TMPRSS2-ERG fusion in biopsy tissues was performed by fluorescence in situ hybridization and the expression of ERG and Forkhead box P3 was detected by gel electrophoresis, real-time quantitative reverse transcription polymerase chain reaction and Western blot. Enzyme-linked immunosorbent assay and flow cytometry were used to analyze transforming growth factor β levels and the number of regulatory T cells, respectively. Finally, the infiltration of regulatory T cells was analyzed by Forkhead box P3 immunohistochemistry.ResultsFluorescence in situ hybridization analysis showed that the TMPRSS2-ERG fusion gene was positive in prostate cancer and that the messenger RNA and protein expression of ERG were significantly up-regulated in prostate cancer biopsy tissues. Furthermore, the number of regulatory T cells and the levels of Forkhead box P3 and transforming growth factor β were significantly increased in prostate cancer. TMPRSS2-ERG fusion increased the migration and activation of regulatory T cells in vitro and promoted subcutaneous tumor size and regulatory T cells infiltration in mouse models.ConclusionsTMPRSS2-ERG fusion can regulate the recruitment and infiltration of regulatory T cells to promote tumor growth in prostate cancer.
       
  • Immunological In Vivo and In Vitro Investigations of Aqueous Extract of
           Stem Bark of Pterocarpus erinaceus Poir (Fabaceae)
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Oumar Mahamat, Tume Christopher, Ateufack Gilbert, Ngo Teke Gerald, Kamanyi AlbertAbstractBackgroundMacrophages are the first cells to recognize invading foreign bodies and are central to cell mediated and humoral immunity. Therefore, the activation of macrophages is a key event for effective innate and adaptive immunity. Pterocarpus erinaceus has been reported to control infectious diseases, but the mechanism remains to be elucidated. In this study, we demonstrated the immune-modulatory effect of aqueous extract of P. erinaceus using human macrophages and lymphocytes, as well as mice.MethodsHot water was used to extract P. erinaceus from the stem bark. Its effect on lymphocytes was measured by evaluating proliferative response and delayed hypersensitivity. Phagocytic activity of macrophages were measured based on neutral red uptake assay, nitric oxide production and myeloperoxidase and phosphatase acid activity. Hematopoietic and infectious activities were analyzed using the effect on infectious stress and chloramphenicol-induced leucopenic mice model.ResultsAqueous extract showed stronger stimulatory effects on the neutral red uptake, production of nitric oxide and phosphatase acid activity in lipopolysaccharide-activated macrophages. In addition, aqueous extract significantly stimulated the proliferation of phytohemagglutinin-activated lymphocytes, enhanced delayed hypersensitivity response to erythrocytes and attenuated infection-induced fever. Furthermore, aqueous extract also significantly increased the rate of recovery of white blood cell levels in chloramphenicol-induced leucopenia mice.ConclusionsThe results suggest that aqueous extract of P. erinaceus stem bark is able to modulate the immune system and has potential effects in clinical conditions when an immune-enhancing and anti-infectious effect is desired.
       
  • Sustained Cardiac Recovery Hinges on Timing and Natural History of
           Underlying Condition
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Abhishek Jaiswal, Thierry H. Le Jemtel, Rohan Samson, Donna ManciniAbstractThe review underlines that advanced heart failure (AHF) patients who experience sustained cardiac recovery in the current left ventricular assist device (LVAD) era have similar clinical characteristics to those who experienced myocardial recovery in the pre-LVAD era. They are young, do not have coronary artery disease and were treated for idiopathic dilated cardiomyopathy within weeks to months of experiencing symptoms. As recently shown with progressive remodeling of the transverse tubular system, AHF results in myocyte and extracellular matrix alterations that with time become irreversible. Young age, short duration of symptoms and LV systolic dysfunction as evidenced by smaller LV cavity dimension are primary determinants of sustained cardiac recovery in patients with AHF. Mechanical circulatory support can be life saving in patients with low-cardiac output and end-organ dysfunction. However, the underlying condition and not mechanical circulatory support appears to be the primary determinant of sustained myocardial recovery.
       
  • Emerging role for exosomes in the progress of stem cell research
    • Abstract: Publication date: Available online 19 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Yuan Kai-Ming, Zhang Pei-Hua, Qi Shan-Shan, Zhu Qiao-Zhen, Li PingAbstractExosomes are small secretory vesicles that are involved in intercellular communication. Exosomes are secreted by many types of cells and exert important functions in plasma-membrane exchange as well as the transport of bioactive substances, such as proteins, messenger ribonucleic acids (mRNAs), micro ribonucleic acids (miRNAs) and organelles. Exosomes may regulate physiological processes by altering gene regulatory networks or epigenetic recombination. Recent studies have shown that exosomes secreted by stem cells can effectively transport proteins, mRNAs and miRNAs and play important roles in the regulation of tissue regeneration. This report reviews current progress in exosome studies as well as their emerging roles in stem cell research and potential clinical use.
       
  • The Acute effects of cigarette smoking on the functional state of high
           density lipoprotein
    • Abstract: Publication date: Available online 19 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Si-Qi Shen, Hui Chang, Zi-Xi Wang, Hong-Ying Chen, Lian-Feng Chen, Feng Gao, Xiao-Wei YanAbstractBackgroundCigarette smoking disturbs plasma lipid level and lipoprotein metabolism; however, the effects of smoking on the functional state of high density lipoprotein (HDL) are still not clear. This study aimed to determine the anti-oxidant and anti-chemotactic properties of HDL and HDL-mediated cholesterol efflux in healthy subjects after cigarette smoking.MethodsHealthy male subjects, including nonsmokers (n=16) and chronic smokers (n=8), were enrolled. After smoking 8 cigarettes within 2 hours, plasma HDL was isolated and tested. Copper-induced LDL oxidation was used to determine the anti-oxidant ability of HDL. The concentration of SAA was measured by ELISA. Chemotaxis was detected by transwell assay. HDL-mediated cholesterol efflux was measured using fluorescent cholesterol analog.ResultsLow density lipoprotein (LDL) baseline oxidation state was higher in chronic smokers than that in nonsmokers. Meanwhile, HDL-induced cholesterol efflux in macrophages in chronic smokers was significantly enhanced compared with that in nonsmokers. After acute smoking, both the anti-oxidant and anti-chemotactic ability of HDL declined in nonsmokers. However, in healthy chronic smokers, the effect of HDL on the susceptibility of LDL to oxidation was compensatorily enhanced. Nevertheless, their bodies were still in a higher oxidation state. Also, acute smoking did not affect HDL-mediated cholesterol efflux significantly in both nonsmokers and chronic smokers.ConclusionsOur data suggest that acute smoking attenuates the anti-oxidant and anti-chemotactic abilities of HDL in nonsmokers. Chronic smokers are in a higher oxidative state, although the anti-oxidant function of their HDL is compensatorily enhanced.
       
  • Hemophagocytic lymphohistiocytosis in the elderly
    • Abstract: Publication date: Available online 17 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Reyna Altook, Mohammed Ruzieh, Avneet Singh, Wael Alamoudi, Zeinab Moussa, Hussam Alim, Fadi Safi, Joan DugganAbstractHemophagocytic lymphohistiocytosis (HLH) is a rare disease of massive, dysregulated cytokine release and secondary multi-organ failure, and is associated with high mortality. Primary HLH occurs predominately in infants and young children with a genetic predisposition. Acquired HLH is less well characterized and usually occurs in younger adults in the setting of severe inflammation triggered by infection or malignancy. Little is known about the disease in elderly. We report 3 patients>50 years old who presented with multi-organ failure and shock without an identifiable source and were ultimately diagnosed with acquired HLH. We performed a literature review of HLH in adults>50 years of age and identified an additional 68 cases. Mean age was 62 years, with male predominance. Most cases were triggered by infection (49%) followed by malignancy (27%). Nineteen patients were treated with the HLH-94 protocol, 11 received corticosteroids and the remainder received non-HLH specific interventions. Overall mortality was 62%.
       
  • The clinical impact of glomerular immunoglobulin M deposition in patients
           with type 2 diabetic nephropathy
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Xi Tang, Hanyu Li, Li li, Junlin Zhang, Huan Xu, Lin Li, Fang LiuAbstractBackgroundGlomerular Immunoglobulin M (IgM) deposition is common in diabetic kidney disease. The clinical implication of IgM deposition in the renal tissues of type 2 diabetes (T2DM) patients with biopsy-proven diabetic nephropathy (DN) remains unclear.MethodsOne hundred thirty-two patients with T2DM and biopsy-proven pure DN were enrolled retrospectively. Clinicopathological features and renal outcomes were compared between patients with and without glomerular capillary IgM deposition. A Cox proportional hazards model was employed to identify the risk factors associated with renal survival.ResultsFifty-two patients had positive linear glomerular capillary IgM staining. Patients with glomerular capillary IgM deposition presented with heavier proteinuria, lower serum albumin, and lower immunoglobulin G (IgG) levels. During 35.5 (12, 107) months of follow-up, patients with glomerular tuft IgM deposition had shorter renal survival than those with negative IgM deposition (39 [23.74, 54.26] vs. 64 [45.82, 82.18] months, P = 0.01). Patients with glomerular C1q deposition showed worse renal survival than those lacking glomerular C1q deposition (36 [23.82, 48.18] vs. 60 [50.27, 69.74] months, P = 0.001). Worse renal outcome was observed in patients with glomerular C3 deposition than in those without glomerular C3 deposition (37 [22.43, 51.56] vs. 63 [51.75, 74.25] months, P = 0.001). Multivariate Cox proportional analysis demonstrated that combined glomerular capillary IgM and C1q deposition (HR 3.75, 95% CI [1.68, 8.35], P = 0.001) was an independent predictor of end-stage renal disease.ConclusionsPatients with diabetic nephropathy and combined glomerular capillary IgM and C1q deposition had unfavorable renal outcome, which indicates that IgM derived from B cells might be involved in diabetic kidney injury.
       
  • Does Timing Matter' Using Lactate to Predict Outcomes
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Michael Baram, Bharat Awsare
       
  • A case of Takayasu Arteritis with the ostium of left main coronary artery
           obstructed by prolapsed thickened ascending aortic intima
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Jiayue Feng, Sen He, Hua Wang
       
  • Walter Reed at Camp Lazear: A Paradigm for Contemporary Clinical Research
    • Abstract: Publication date: Available online 5 July 2018Source: The American Journal of the Medical SciencesAuthor(s): David PlothAbstractThroughout the time of the early settlement and development of North America there were frequent epidemics of Yellow Fever. Yellow fever was particularly threatening because it was associated with an extremely high mortality rate; up to 85% of those infected died of the disease. Yellow Fever in the Western world is likely an additional, horrific by-product of early slavery in North America. It is thought that ships transporting captured Africans likely conveyed both the major vector, the Aedes aegypti mosquito, and the RNA Yellow Fever virus from Africa to North America. Infected ships landing in port cities resulted in epidemics that proved impossible to control with conventional interventions. Walter Reed and the U.S. Army Commission solved the mystery of the mode of Yellow Fever transmission. Notably, Reed and his co-workers not only proved the mosquito the vector of transmission but did so by constructing focused research questions leading to cleverly devised experiments that resulted in definitive answers. The results of their research not only proved that the mosquito transmitted the disease, but disproved the other proposed modes of transmission. In nearly all respects Reed's experiments are an excellent paradigm for addressing clinical research questions today.
       
  • SAFMR/SSCI Junior Faculty Research Travel Awards
    • Abstract: Publication date: Available online 30 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Autoimmune thyroid disease in patients with systemic lupus erythematosus:
           a 7-year retrospective study in China
    • Abstract: Publication date: Available online 30 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Shanshan Wei, Zhenghui Yang, Shuangde Xie, Xuebiao Peng, Li Gong, Ke Zhao, Kang Zeng, Kuan LaiAbstractBackgroundThe study was a retrospective case-controlled study. We aimed to determine the clinical and laboratory features of systemic lupus erythematosus (SLE) and compared the features of autoimmune thyroid disease (AITD) with those of SLE.MethodsThe study included 38 patients with SLE with AITD (SLE-AITD) and 190 age- and gender-matched SLE patients. The distribution of sociodemographic and clinical factors was compared between the SLE-AITD and SLE groups using Chi-square tests for gender and t tests for others. Univariate and multivariate logistic regression models were used to identify factors associated with the prevalence of AITD among SLE patients.ResultsIn univariate analysis, malar rash, oral ulcers, serositis, anti-double-stranded DNA antibody positivity (anti-dsDNA+), anti-Sjögren's syndrome type A antibodies (SSA), anti-Sjögren's syndrome type B antibodies (SSB), low complement 3 (C3), and low complement 4 (C4) were significantly different between the SLE-AITD and SLE groups. There were no significant differences among other clinical or laboratory features. In multivariate analysis, serositis (adjusted odds ratio [AOR], 3.64; P = 0.00), anti-dsDNA+ (AOR, 0.30; P = 0.01) and low C3 (AOR, 0.30; P = 0.02) were all associated with SLE-AITD.ConclusionsIn our study, serositis was a risk factor for AITD, so we propose that AITD should be considered in lupus patients with serositis.
       
  • Executive Summary
    • Abstract: Publication date: Available online 26 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • HIGHLIGHTS FROM THE 2018 SOUTHERN REGIONAL MEETING
    • Abstract: Publication date: Available online 25 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Expression of cytosolic phospholipase A2 alpha in glioblastoma is
           associated with resistance to chemotherapy
    • Abstract: Publication date: Available online 25 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lei Yang, Haiyan ZhangAbstractBackgroundThe clinical management of glioblastoma is still challenging despite aggressive surgery and radio-chemotherapy approaches. Better understanding the molecules involved in glioblastoma chemoresistance is necessary to improve the treatment and predict prognosis.Materials and MethodsWe analyzed the expression and possible roles of cytosolic phospholipase A2 alpha (cPLA2α) in human glioblastoma cell lines and patient samples using immunohistochemistry and cellular assays. We analyzed the signaling pathways that cPLA2α regulates in glioblastoma cells using western blot.ResultsOur work demonstrated that cPLA2α is upregulated in glioblastoma compared with normal neuron cells. The expression of cPLA2α varies in multiple glioblastoma cell lines and is associated with chemoresistance rather than tumor development. cPLA2α depletion moderately inhibits glioblastoma growth and survival but remarkably sensitizes chemo-resistant glioblastoma cells to several chemotherapeutic agents. Mechanistically, cPLA2α knockdown significantly suppresses the PI3K/Akt/mTOR pathway in glioblastoma cells.ConclusionsWe are the first to identify the important role of cPLA2α in glioblastoma in response to chemotherapy. Our data also suggest that cPLA2α may serve as a biomarker to indicate prognosis of glioblastoma patients with high level of cPLA2α to chemotherapy.
       
  • Folliculotropic mycosis fungoides with CD30+ large-cell transformation
    • Abstract: Publication date: Available online 23 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lei Yao, Yan Yu, Yu Guo, Shan-shan Li
       
  • Complete Heart Block in Acute Aortic Dissection: An Unusual Presentation
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Kiran Kumar Gudivada, Ashish Kumar Umesh, Akarsh Reddy Budibetta Sudeendrababu
       
  • Thiamine deficiency: An important consideration in critically ill patients
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Pradeep Attaluri, Austin Castillo, Hawa Edriss, Kenneth NugentAbstractThiamine is an essential cofactor for 4 enzymes involved in the production of energy (ATP) and the synthesis of essential cellular molecules. The total body stores of thiamine are relatively small, and thiamine deficiency can develop in patients secondary to inadequate nutrition, alcohol use disorders, increased urinary excretion, and acute metabolic stress. Patients with sepsis are frequently thiamine deficient, and patients undergoing surgical procedures can develop thiamine deficiency. This deficiency can cause congestive heart failure, peripheral neuropathy, Wernicke's encephalopathy, Korsakoff's syndrome, and gastrointestinal beriberi. In addition, thiamine deficiency can contribute to the development of intensive care unit complications, such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction, and unexplained lactic acidosis. Consequently, clinicians need to consider thiamine deficiency in patients admitted to intensive care units and the development of thiamine deficiency during the management of critically ill patients. Intravenous thiamine can correct lactic acidosis, improve cardiac function, and treat delirium.
       
  • Efficacy and safety of policosanol plus fenofibrate combination therapy in
           elderly patients with mixed dyslipidemia: a randomized, controlled
           clinical study
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Hai–ya Wang, Qing–ping Jiao, Shu–yan Chen, Jing Sheng, Hua Jiang, Jie Lu, Song-bai Zheng, Ning-yuan FangABSTRACTBackgroundPolicosanol is a mixture of long-chain alcohols isolated from sugar cane. This controlled, randomized clinical trial was designed to compare the efficacy and safety of fenofibrate, policosanol and a combination of these 2 in lowering low-density-lipoprotein cholesterol (LDL-C) in elderly patients with mixed dyslipidemia.MethodsA total of 102 patients aged ≥60 years were randomly assigned into 3 groups: patients receiving a 24-week therapy of fenofibrate (200 mg/day), policosanol (20 mg/day), or fenofibrate + policosanol combination. Lipids were evaluated at baseline, after 16- and 24-weeks of therapy. Brachial-ankle pulse wave velocity (ba-PWV) was performed, and SF-36 questionnaires were used to evaluate the patients’ quality of life. The primary endpoint was the percentage reduction in LDL-C. The secondary endpoints included percentage change in non-high density lipoprotein cholesterol(non-HDL-C), total cholesterol (TC), triglyceride (TG), high-density-lipoprotein cholesterol (HDL-C), ba-PWV and SF-36 scores. Safety was assessed by adverse events and laboratory parameters.ResultsLDL-C, non-HDL-C and TC were decreased respectively after treatment with policosanol for 24 weeks (P
       
  • Sex-based Differences in Heart Failure with Preserved Ejection Fraction
           Reflected by B-type Natriuretic Peptide Level,
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Eisaku Harada, Yuji Mizuno, Fumihito Kugimiya, Makoto Shono, Hiroyuki Maeda, Naotsugu Yano, Hirofumi YasueAbstractBackgroundPrevalence of heart failure with preserved ejection fraction (HFpEF) increases with advancing age, particularly among women. Plasma levels of B-type natriuretic peptide (BNP), a surrogate marker of HF, have consistently been shown to be higher in women in the general populations. Whether BNP levels differ as per the sex of HFpEF patients remains largely unknown.Materials and MethodsThe study subjects were 733 HFpEF patients (204 men and 529 women, aged 80.9 ± 9.6 years) who underwent echocardiography and routine clinical examination, including plasma BNP level evaluation. These parameters were compared between women and men.Results: Plasma levels of BNP were significantly lower in women than in men [104 (61, 192) vs. 133 (78, 255) pg/mL, P < 0.001], just as hemoglobin, atrial fibrillation, diabetes mellitus, beta-blockers, left ventricular diastolic dimension, left ventricular mass index, left ventricular eccentric hypertrophy, and left atrial dimension were. Age, systolic blood pressure, pulse pressure, heart rate, left ventricular relative wall thickness, left ventricular ejection fraction, and left ventricular concentric hypertrophy were higher in women than in men. Multiple regression analyses revealed that left ventricular mass index, body massn index, early diastolic mitral flow velocity/tissue annular motion velocity/left ventricular diastolic dimension, estimated glomerular filtration rate, beta-blockers, left atrial dimensions, female sex, and atrial fibrillation were significant predictors for BNP levels (t = 5.41, P < 0.001, t = -4.06, P < 0.001, t = 3.76, P < 0.001, t = -3.68, P < 0.001, t = 3.32, P = 0.001, t = 3.11, P = 0.002, t = -3.07, P = 0.002, and t = 2.65, P = 0.008, respectively).ConclusionsPlasma BNP levels were lower in women and were related to left ventricular concentric remodeling/hypertrophy among HFpEF patients, contrary to those in the general population.
       
  • Is Dietary Protein Intake Predictive of One-Year Mortality in Dialysis
           Patients',,✰✰✰
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): David P. Murray, Lufei Young, Jennifer Waller, Stephanie Wright, Rhonda Colombo, Stephanie Baer, Vanessa Spearman, Rosalia Garcia-Torres, Kori Williams, Mufaddal Kheda, N. Stanley NahmanAbstractBackgroundHigh mortality in dialysis patients may be associated with protein-energy wasting (PEW) syndrome characterized by progressively depleted protein and energy stores. While early diagnosis and treatment of PEW can reduce mortality, clinically practical measures for its detection are lacking. Poor dietary protein intake (DPI) is associated with risk of malnutrition and PEW. However, the impact of DPI on mortality is unclear. The purpose of this study is to examine the ability of DPI to predict 1-year mortality in dialysis patients.MethodsThis prospective, secondary study using data from the Comprehensive Dialysis Study (CDS) and United States Renal Data System examined risk factors associated with 1-year mortality in dialysis patients.ResultsSeventeen (7.5%) of the 227 subjects died within 1 year following baseline data collection. One year survivors were significantly younger (60±13.6 vs. 71±12.8; P = 0.0043), had a lower Charlson Comorbidity Index (CCI) score (1.6±2.3 vs. 4.0±3.6; P = 0.0157), higher serum albumin level (3.5±0.5 vs. 3.3±0.4; P = 0.0173), and had higher DPI (63±33.7 vs. 49.5±21.5 g/day; P = 0.0386) than those who died. In multivariable Cox proportional hazards model analyses, only the CCI adjusted hazard ratio for death (1.24) was significantly associated with increased mortality. The CDS data showed no association between DPI and 1-year mortality in dialysis patients.ConclusionsFuture studies using more precise measures should further examine the impact of DPI on mortality given the known association of DPI with PEW syndrome and the definitive link between PEW syndrome and survival in dialysis patients.
       
  • Complications of Cirrhosis in Primary Care: Recognition and Management of
           Hepatic Encephalopathy
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Steven L. FlammAbstractApproximately 3.7% of patients in primary care settings have chronic liver disease, and 18% with chronic liver disease, in the specialty care setting, have cirrhosis. For cirrhotic patients without complications, prognosis is generally favorable; increased morbidity and mortality are observed when complications (ie, hepatic encephalopathy [HE]) occur. HE occurs in up to 70% of patients with cirrhosis. Neurologic signs in HE span a wide spectrum, from those not easily apparent (covert) to more clinically obvious signs (overt). Providers should consider overt HE in patients with cirrhosis and signs of impaired cognition, confusion, consciousness and/or personality changes, and/or impaired memory. Overt HE treatment includes identifying and treating precipitating factors and reducing bacterial-derived toxin loads. For acute overt HE, lactulose is first-line treatment. To prevent HE recurrence, lactulose plus rifaximin is recommended. Patients with cirrhosis and HE often present in primary care; recognizing and properly managing HE are important in this setting.
       
  • Effect of trimetazidine on preventing contrast-induced acute kidney injury
           in patients with diabetes
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Weidai Zhang, Kefei Wu, Hanfei Lin, Jiawei Zhang, Songming Chen
       
  • "This is a Christian institution and we will tolerate no Jews here": The
           Brooklyn Medical Interns Hazings
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Edward C. HalperinAbstractAnti-Semitic quotas to restrict access to medical school, graduate medical education, and hospital privileges were common in the US from the 1920’s to the 1960’s. In Brooklyn, New York, medical education prejudice resulted in violence. In 1916 a Jewish intern at Kings County Hospital (KCH), Matthew Olstein, was bound and gagged by Christian interns, put on a train at Grand Central Station, and warned that if he returned he would be thrown in the East River. Olstein died in combat in World War I as an Army physician. In 1927 three Jewish interns at KCH were assaulted, bound, dumped in tubs of water, and covered in black fluid. Six gentile physicians were charged with assault. Criminal proceedings and public investigations followed. These attacks are the only known episodes of violence associated with American medical education anti-Semitism.
       
  • Sepsis: An update in current practices in diagnosis and management
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Snigdha JainAbstractDespite several advancements in care over the last few decades, sepsis continues to carry a high morbidity and mortality burden in the United States. With its varied presentations, cases of sepsis are likely to be encountered by general practitioners in both inpatient and outpatient settings. In the recent years, there has been much debate about the appropriate criteria to diagnose patients with sepsis with a concurrent change in management guidelines. This article reviews definitions, diagnosis and treatment guidelines in current practice in the management of patients with sepsis.Case presentationA 60-year-old man presented to the emergency department with a 2-day history of chills and dysuria. His medical history was significant for hypertension for which he was taking amlodipine 5 mg daily. Vital signs in the emergency department were significant for a temperature of 38.7°C (101.5°F), heart rate of 120 beats/minute, blood pressure of 90/60 mm Hg, respiratory rate of 20 breaths/ minute, and oxygen saturation of 95% on room air. Physical examination revealed dry mucous membranes, tachycardia without gallops, rubs, or murmurs, clear lungs and warm extremities. Abdominal exam was significant for tenderness on palpation of his suprapubic region. Laboratory testing showed a creatinine level of 1.6 mg/dL (reference range, 0.5 to 1.1 mg/dL) - up from a baseline creatinine of 0.9 mg/dL 4 weeks prior, blood urea nitrogen of 56 mg/dL (reference range, 7 to 20 mg/dL), white-cell count of 18,000/mm3 (reference range, 4500 to 11,000 cells/mm3), hemoglobin of 9.0 g/dL (reference range, 12.0 to 15.5 g/dL) and lactate of 2 mmoL/L (reference range, 0.5-2 mmoL/L). Urinalysis showed 3+ leukocyte esterase,>100 white cells per high-power field, and many bacteria.Does this patient have sepsis' How would you treat him'
       
  • FROM SQUIRRELS TO BIOLOGICAL WEAPONS: THE EARLY HISTORY OF TULAREMIA
    • Abstract: Publication date: Available online 15 June 2018Source: The American Journal of the Medical SciencesAuthor(s): J.V. HirschmannAbstractAfter George McCoy accidentally discovered a new infection in 1911 while investigating bubonic plague in squirrels, he transmitted the disease to experimental animals and isolated the causative organism. He called it Bacterium tularense, after Tulare County, California. In 1919, Edward Francis determined that an infection called “deer-fly fever” was the same disease, naming it “tularemia.” He demonstrated that it occurred in wild rabbits and inadvertently showed that it was highly infectious, for he and all his laboratory assistants contracted the illness. This characteristic led to studies of its potential as a biological weapon, including involuntary human experimentation by Japan among civilian, political and military prisoners, and its probable use in warfare during World War II. Later, in the United States, voluntary human experimentation occurred in the 1950s-60s with penitentiary inmates and non-combatant soldiers. Soviet Union scientists allegedly developed a vaccine-resistant strain, which they tested as a biological weapon in 1982-3.
       
  • Extensive Calcinosis Cutis in Overlap Syndrome
    • Abstract: Publication date: Available online 13 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Yamen Homsi
       
  • Hematuria and Renal Outcomes in Patients with Diabetic Chronic Kidney
           Disease
    • Abstract: Publication date: Available online 12 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Hugo You-Hsien Lin, Sheng-Wen Niu, I-Ching Kuo, Lee-Moay Lim, Daw-Yang Hwang, Jia-Jung Lee, Shang-Jyh Hwang, Hung-Chun Chen, Chi-Chih HungAbstractBackgroundHematuria may indicate nondiabetic renal disease in diabetic chronic kidney disease (CKD). However, some studies have reported that hematuria is noted in diabetic nephropathy and is associated with albuminuria. Hematuria is a risk factor for end-stage renal disease in glomerulonephritis, but its prognostic value in diabetic CKD is unknown. We investigated the factors associated with hematuria and the prognostic value of hematuria in patients with diabetic CKD.Material and MethodsWe included 1958 patients with type 2 diabetes and CKD stages 1–5, and 111 patients underwent renal biopsy. Patients in the biopsied cohort were younger and had more severe proteinuria, compared with those in the total cohort; hematuria was associated with nondiabetic renal disease.ResultsIn the total cohort, hematuria was observed in 15.0% of the patients and was associated with young age, a lower estimated glomerular filtration rate, proteinuria, high blood pressure, and short diabetes duration. Hematuria was significantly associated with an increased risk (hazard ratio 1.39, 95% CI: 1.10–1.76, P < 0.001) of end-stage renal disease, particularly in patients with CKD stages 1–3 or a urine protein-to-creatinine ratio of
       
  • Sudden Cardiac Arrest in a Young Patient with Severe Pectus
           Excavatum,
    • Abstract: Publication date: Available online 9 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Rayan Jo Rachwan, Andrea K. Purpura, Basil M. KahwashAbstractWe report a case of sudden cardiac arrest in the setting of ventricular fibrillation in a previously healthy 19-year-old male. Chest imaging demonstrated severe pectus excavatum with Pectus Severity Index of 22.7. Extensive workup was unrevealing for other cardiopulmonary etiologies, including conduction and structural abnormalities. The patient was scheduled for a Ravitch procedure and was discharged on a wearable defibrillator vest for temporary protection against ventricular arrhythmias. Later, the patient underwent subcutaneous implantable cardioverter defibrillator placement. Sudden cardiac arrest as an initial presentation of pectus excavatum is a rare entity scarcely discussed in medical literature. In this patient-centered focused review, we explore this unique case and offer our management approach amid the lack of concrete guidelines.
       
  • Timing of Left Ventricular Remodeling in Non-ischemic Dilated
           Cardiomyopathy,,✯✯✯
    • Abstract: Publication date: Available online 8 June 2018Source: The American Journal of the Medical SciencesAuthor(s): William S. Bradham, Susan P. Bell, Shi Huang, Frank E. Harrell, Douglas W. Adkisson, Mark A. Lawson, Douglas B. Sawyer, Henry Ooi, Marvin W. KronenbergABSTRACTBackground: Mineralocorticoid receptor antagonist (MRA) treatment produces beneficial left ventricular (LV) remodeling in nonischemic dilated cardiomyopathy (NIDCM). This study addressed the timing of maximal beneficial LV remodeling in NIDCM when adding MRA.Methods: We studied 12 patients with NIDCM on stable beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor-blocking therapy who underwent cardiac magnetic resonance imaging before and after 6-31 months of continuous MRA therapy.Results: At baseline, the LV ejection fraction (LVEF) was 24 (19, 27)% (median, interquartile range). The LV end-systolic volume index (LVESVI) was 63 (57, 76) ml, and the LV stroke volume index (LVSVI) was 19 (14, 21) ml, all depressed. After adding MRA to the HF regimen, the LVEF increased to 47 (42, 52)%, with a decrease in LVESVI to 36 (33, 45) ml, and increase in LVSVI to 36 (28, 39) ml (for each, P 
       
  • The S-Curve Discontinuity Theory Applied to Medicine to Explain
           Healthcare's Past and Predict Its Future
    • Abstract: Publication date: Available online 6 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lisa B.E. Shields, Tyler A. Gertz, Kenneth C. Wilson, Ginger L. Figg, Steven T. Hester, Joshua T. HonakerAbstractDeveloped in 1845 by Verhulst, the logistic growth curve is an “S” shaped sigmoid curve referring to the self-limiting population growth in ecology. The initial growth stage is exponential, followed by slowing of growth as saturation begins, and ending of growth at maturity. In geology, an uncertain period exists at the upper horizontal arm of the S-curve when a species utilizes its available resources, and either extinction or evolution by natural selection results.The S-curve has been used in biology, physics, mathematics, chemistry, economics, sociology, oncology, and statistics. The S-curve theory has been applied to medicine to describe the advancements in the 20th century based on the diagnosis and treatment of disease (the “illness” model) and envision the future focused on disease prevention (the “wellness” model). We expand upon previous S-curve applications in medicine and discuss the obstacles facing the present-day healthcare industry and the numerous advancements that are imminent.
       
  • Hyponatremia complicating esophageal carcinoma: a challenging differential
           diagnosis
    • Abstract: Publication date: Available online 6 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lina Mackelaite, Eleanor LedererAbstractHyponatremia is a common complication of cancer and of cancer therapy. Awareness of the many causes of hyponatremia in this setting is critical for ordering the appropriate diagnostic tests, instituting the appropriate treatment, and assessing prognosis of the disorder. This case report highlights the challenges in identifying the cause of hyponatremia in some oncology settings and how misdiagnosis can delay appropriate therapy.
       
  • Shiga Toxin as a Potential Trigger of CFHR1 deletion- associated
           Thrombotic Microangiopathy
    • Abstract: Publication date: Available online 5 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Swarna Sri Nalluru, Meera Sridharan, Ronald S. Go, Samar Said, Ariela L. MarshallAbstractThrombotic microangiopathy (TMA) may result from a variety of clinical conditions, including thrombotic thrombocytopenic purpura (TTP), Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS), and complement-mediated hemolytic uremic syndrome (C-HUS). TTP is diagnosed when ADAMTS13 is
       
  • Editorial
    • Abstract: Publication date: Available online 5 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Women's Health in Inflammatory Bowel Disease
    • Abstract: Publication date: Available online 2 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Sai S. Veerisetty, Stephanie O. Eschete, Ann-Porter Uhlhorn, Kara M. De FeliceAbstractAbout half of all inflammatory bowel disease (IBD) patients are women. It is important that physicians are aware of gender-specific needs women with IBD may have. This review covers general and specific women's health issues related to their IBD. It is intended to be practical and give a brief overview of topics including body image, menstruation, contraception, cervical cancer screening, preconception counseling, anxiety, depression, pregnancy, breastfeeding, menopause, skin exams, vaccines, laboratory monitoring and bone health.
       
  • An offer we can't refuse: cfDNA as a novel biomarker of myocardial
           infarction
    • Abstract: Publication date: Available online 1 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Daria V. Ilatovskaya, Kristine Y. DeLeon-Pennell
       
  • Tricuspid Regurgitation Pressure Gradient As a Useful Predictor Of Adverse
           Cardiovascular Events And All-cause Mortality In Patients With Atrial
           Fibrillation
    • Abstract: Publication date: Available online 22 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Po-Chao Hsu, Wen-Hsien Lee, Chun-Yuan Chu, Wei-Chung Tsai, Hung-Hao Lee, Chee-Siong Lee, Hsueh-Wei Yen, Tsung-Hsien Lin, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu, Ho-Ming SuAbstractBackgroundTricuspid regurgitation pressure gradient (TRPG) is reportedly a predictor of cardiovascular mortality in patients without atrial fibrillation (AF); its relationship with cardiac outcomes in patients with AF has never been evaluated. This study aimed to examine the ability of TRPG for predicting CV events and all-cause mortality in patients with AF.Materials and MethodsComprehensive echocardiography was performed in 155 patients with persistent AF. Combined cardiovascular events were defined as cardiovascular mortality, stroke, and hospitalization for heart failure.ResultsDuring an average follow-up period of 27 months, 57 cardiovascular events and 31 all-cause deaths occurred. According to multivariate analysis, predictors of cardiovascular events included diuretic use, decreased left ventricular ejection fraction (LVEF), increased ratio of transmitral E velocity (E) to early diastolic mitral annular velocity (E′), and TRPG. Predictors of all-cause mortality included old age, decreased LVEF, increased E/E′, and TRPG. Notably, the addition of TRPG to a model containing clinical significant parameters, LVEF, and E/E′ significantly improved the values in predicting adverse cardiovascular events and all-cause mortality.ConclusionsThe TRPG is not only a useful predictor of adverse cardiovascular events and all-cause mortality in patients with AF, it may also provide additional prognostic values for cardiovascular outcome and all-cause mortality over conventional parameters in such patients.
       
  • The Summer Enrichment Program: A Multidimensional Experiential Enriching
           Experience for Junior Medical Students
    • Abstract: Publication date: Available online 16 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Abdulhadi A. AlAmodi, Ahmed Abu-Zaid, Abdulaziz M. Eshaq, Khaled Al-Kattan
       
  • Variation in high-intensity statin use after hospitalization for acute
           vascular emergencies
    • Abstract: Publication date: Available online 16 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Anusha Shanbhag, Aneesha Ananthula, Raga Deepak Reddy Palagiri, Richa Parikh, Raghunandan Purushothaman, Srikanth Vallurupalli
       
  • IgG4-related pleuritis with no other organ involvement
    • Abstract: Publication date: Available online 9 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Toshiyuki Kita, Tomoyuki Araya, Yukari Ichikawa, Nanao Terada, Atsuhiro Kawashima, Satomi Kasashima, Kazuo KasaharaAbstractA 65-year-old man was admitted for productive cough and dyspnea. Bilateral pleural effusions were observed on chest X-ray. Although the bilateral pleural effusions were exudative, with an increased number of lymphocytes, bacterial culture and polymerase chain reaction analysis for Mycobacterium tuberculosis was negative. Immunological examinations showed high levels of immunoglobulin G4 (IgG4) in both serum and pleural effusion fluid. Pathologic evaluation of a left pleural biopsy specimen using hematoxylin–eosin and immunohistochemical staining showed fibrosis-associated lymphoplasmacytic infiltration, 50 IgG4-positive plasma cells per high-power field, and an IgG4/IgG ratio of 40%. Thus, a diagnosis of IgG4-related pleuritis without other systemic manifestations was established. The bilateral pleural effusion improved following corticosteroid therapy. This is a rare case of IgG4-related pleuritis with no other organ involvement.
       
  • Prevalence and Incidence of Immune Thrombocytopenia in Patients With
           Prostate Cancer
    • Abstract: Publication date: Available online 5 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Namratha Vontela, Csaba Kovesdy, Zafar Latif, Robert Lane, Alva Weir
       
  • Multimodality diagnosis of Mirizzi syndrome.
    • Abstract: Publication date: Available online 4 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Gunjan Garg, Marisa Deliso, Shuo Li
       
  • 1 &rft.title=American+Journal+of+the+Medical+Sciences&rft.issn=0002-9629&rft.date=&rft.volume=">Experiential Learning in Medical Education 1
    • Abstract: Publication date: Available online 3 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Urvashi Vaid
       
  • Hepatitis B virus infection is independently associated with advanced
           colorectal adenoma
    • Abstract: Publication date: Available online 2 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Su Hwan Kim, Ji Won Kim, Kook Lae Lee, Seohui Lee, Seong-Joon Koh, Ji Bong Jeong, Byeong Gwan KimAbstractIntroductionStudies on the association of chronic hepatitis B virus (HBV) infection with colonic neoplasm are rare. We aimed to investigate the association between chronic HBV infection and the development of colonic adenoma.Materials and MethodsOne hundred thirty-three patients with chronic HBV infection, who underwent colonoscopic examination, were enrolled. A healthy HBV-uninfected group was matched with the HBV group. Those with a previous history of colorectal cancer, inflammatory bowel diseases, or colorectal surgery were excluded from both HBV and HBV-uninfected groups. Clinical information and data on age, sex, body mass index, smoking, alcohol consumption, and comorbidities were obtained. Advanced adenoma was defined as tubular adenoma ≥ 10 mm, or adenoma with a villous component or high-grade dysplasia.ResultsThe HBV group had a higher rate of colorectal adenoma and advanced adenoma than the HBV-uninfected group. Patients in the HBV group had larger colorectal polyps than those in the HBV-uninfected group. In the chi square test, HBV DNA positivity was significantly associated with colorectal adenoma (P < 0.001) and advanced adenoma (P = 0.007). HBV infection (odds ratio [OR] 23.961, 95% CI 9.400–61.076), diabetes mellitus (OR 2.633, 95% CI 1.071–6.473), and age (OR 1.057, 95% CI 1.020–1.095) were significantly associated with advanced adenoma in the multivariable logistic regression analysis. Multivariable logistic regression analysis within the HBV group revealed that HBV DNA (OR 1.236, 95% CI 1.029–1.485) was associated with advanced adenoma.ConclusionsHBV DNA in patients with HBV infection and HBV infection are independently associated with advanced colorectal adenoma development.
       
  • Safely Extubating the Acutely Ill Stroke Patient: By Which Criteria, and
           to What Purpose'
    • Abstract: Publication date: Available online 24 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Eric E. Smith, Philippe Couillard
       
  • Dilemma of Common Bile Duct Dilatation in Opium-addicts: A
           Population-based Study on Prevalence and Clinical Outcome
    • Abstract: Publication date: Available online 7 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Amir Reza Radmard, Faezeh Khorasanizadeh, Hossein Poustchi, Soheil Kooraki, Babak Mirminachi, Maryam Sharafkhah, Elham Jafari, Amir Pejman Hashemi Taheri, Rasoul Stoudehmanesh, Mehdi Mohamadnejad, Reza Malekzadeh, Shahin MeratAbstractBackgroundThis study aimed to evaluate the association of various opium-related factors with common bile duct (CBD) diameter in opium-addicts in the general population and investigate the clinical importance and long-term outcomes.Materials and MethodsIn this prospective study, 2400 participants were randomly selected from the Golestan Cohort study. Opium consumption data were recorded. CBD diameter was measured by ultrasound. Transient elastography was performed at enrollment and 3 years later. Participants were followed up for at least 5 years.ResultsA total of 1599 individuals, aged above 50 years, were enrolled and 167 subjects were opium-addicts. CBD diameter was significantly higher in opium-addicts than controls (mean ± standard deviation:5.54 ± 1.95 vs. 4.74 ± 1.34 mm, P < 0.001). This difference was noted with all opium types, but mostly by heroin users (P < 0.001). Ingestion of opium caused greater CBD dilatation than inhalation (coefficient: 1.16; 95% confidence interval (CI) = 0.05–2.27, P = 0.04 vs. coefficient: 0.98; 95% CI = 0.75–1.20, P < 0.001). Transient elastography results did not show any association between fibroscan score change and CBD diameter. No major related malignancy was seen during follow-up.ConclusionThis study strengthened the evidence of an association of opium use with increased CBD diameter in a population-based setting without significantly increased risk of pancreaticobiliary malignancies or liver fibrosis. We cautiously suggest that opium-induced CBD dilatation may not require further diagnostic work-up.
       
  • High prevalence of renal sat wasting without cerebral disease as cause of
           hyponatremia in general medical wards
    • Abstract: Publication date: Available online 7 April 2018Source: The American Journal of the Medical SciencesAuthor(s): John K. Maesaka, Louis J. Imbriano, Nobuyuki MiyawakiAbstractBackgroundThe approach to hyponatremia is in a state of flux, especially differentiating syndrome of inappropriate antidiuretic hormone secretion (SIADH) from cerebral-renal salt wasting (RSW) because of diametrically opposite therapeutic goals. Considering RSW can occur without cerebral disease, we determined the prevalence of RSW in the general hospital wards.MethodsTo differentiate SIADH from RSW, we utilized an algorithm based on fractional excretion (FE) of urate and non-response to saline infusions in SIADH as compared to excretion of dilute urines and prompt increase in serum sodium in RSW.ResultsOf 62 hyponatremic patients, a) 17 patients (27%) had SIADH, 11 were non-responsive to isotonic saline, and 5 normalized a previously high FEurate after correction of hyponatremia, b) 19 patients (31%) had a reset osmostat (RO) based on normal FEurates and spontaneously excreted dilute urines; c) 24 patients (38%) had RSW, 21 had no clinical evidence of cerebral disease, 19 had saline-induced dilute urines; 2 had undetectable plasma ADH levels when urine was dilute, 10 required 5% dextrose in water to prevent rapid increase in serum sodium, 11 had persistently increased FEurate after correction of hyponatremia and 10 had baseline UNa < 20 mEq/L; d) 1 patient had Addison′s disease with a low FEurate and e) 1 patient (1.6% )had hyponatremia due to hydrochlorothiazide.ConclusionsOf the 24 patients with RSW, 21 had no cerebral disease, supporting our proposal to change cerebral to RSW. Application of established pathophysiologic standards and a new algorithm based on determination of FEurate were superior to the volume approach or determination of urinary sodium [UNa] when identifying the cause of hyponatremia.
       
  • Down-Regulation of miR-218-5p Promotes Apoptosis of Human Umbilical Vein
           Endothelial Cells Through Regulating High-Mobility Group Box-1 in
           Henoch-Schonlein Purpura
    • Abstract: Publication date: Available online 5 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Shao-Fei Yu, Wan-Yu Feng, Shao-Qing Chai, Xiao-Bo Meng, Zhong-Xia Dou, Hua ZhuAbstractBackgroundApoptosis of human umbilical vein endothelial cells (HUVECs) plays an important role in the progression of Henoch-Schonlein purpura (HSP). In the present study, we explored the function of miR-218-5p in HUVEC apoptosis and HSP development.Materials and MethodsHSP rat model was established and peripheral blood mononuclear cells (PBMC) were isolated. The expression of miR-218-5p and high-mobility group box-1 (HMGB1) protein in HUVECs was determined by quantitative real-time polymerase chain reaction and western blot, respectively. Cell apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. The association between miR-218-5p and HMGB1 was determined by luciferase assay. The endogenous expression of related genes was modulated with recombinant plasmids and cell transfection.ResultsMiR-218-5p was down-regulated and HMGB1 was up-regulated in vessels of the lower limb of HSP rats and in HUVECs co-cultured in HSP PBMC supernatant. MiR-218-5p negatively regulated HMGB1 by targeting its 3′-untranslated regions. Over expression of miR-218-5p reversed the increased apoptosis and HMGB1 expression observed in HUVECs co-cultured in PBMC supernatant, whereas miR-218-5p knockdown showed the opposite outcomes. Furthermore, the miR-218-5p mimic demonstrated an inhibitory effect on the apoptosis of HUVECs co-cultured in PBMC supernatant, which was reversed by over expression of HMGB1. In HSP rats, over expression of miR-218-5p attenuated HSP and decreased the level of HMGB1.ConclusionsMiR-218-5p attenuated HSP at least partly through regulating HMGB1 expression and affecting the function of HUVECs.
       
  • Relationship Between Clinical Features and Computed Tomographic Findings
           in Hospitalized Adult Patients with Community-Acquired Pneumonia
    • Abstract: Publication date: Available online 3 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Hyewon Seo, Seung-Ick Cha, Kyung-Min Shin, Jae-Kwang Lim, Seung-Soo Yoo, Shin-Yup Lee, Jaehee Lee, Chang-Ho Kim, Jae-Yong ParkAbstractBackgroundData on the relationship between the clinical and microbiological features of community-acquired pneumonia (CAP) and its computed tomography (CT) findings are limited. The aim of the present study was to investigate the clinic-microbiological features of patients with CAP presenting with ground-glass opacity (GGO) and centrilobular nodules or tree-in-bud pattern on CT images.MethodsPatients with CAP that underwent a CT scan at presentation were retrospectively classified using CT findings into consolidation, GGO, and bronchiolitis groups. These 3 groups were compared in terms of clinical parameters and microbiological data.ResultsForty (2.4%) patients were allocated to the bronchiolitis group and 46 (2.8%) to the GGO group. The most common pathogen in the bronchiolitis group was Mycoplasma pneumoniae, which was significantly more frequently isolated in this group. The bronchiolitis group was characterized by a higher percentage of cough, a lower percentage of chest pain, and lower blood levels of inflammatory markers. Common pathogens in the GGO group were not significantly different from those in the other 2 groups. Unlike that observed in the consolidation group, complicated parapneumonic effusion or empyema was not observed in the bronchiolitis or GGO group. Outcome variables were similar in the 3 groups.ConclusionsThe bronchiolitis group was characterized by a higher frequency of M pneumoniae and a less severe form of CAP. The GGO and consolidation groups was similar with respect to causative microorganisms and the clinical features of CAP. No patient in the bronchiolitis or GGO group exhibited complicated parapneumonic effusion or empyema.
       
 
 
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