for Journals by Title or ISSN
for Articles by Keywords
help

Publisher: Elsevier   (Total: 3049 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 3080 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 86, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 363, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 229, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 24, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 132, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 26, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
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: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 45, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 51, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 8, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 360, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 44, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 331, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 417, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 40, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 55, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 40, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 199, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 59, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 25, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 35, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 58, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 12)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 166, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 172, SJR: 1.907, h-index: 126)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover American Journal of the Medical Sciences
  [SJR: 0.653]   [H-I: 70]   [12 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9629
   Published by Elsevier Homepage  [3049 journals]
  • Spontaneous Pneumomediastinum in Dermatomyositis
    • Authors: Vishnu Mohan; Sujith V. Cherian
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Vishnu Mohan, Sujith V. Cherian


      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.06.027
       
  • Mulberry-Shaped Gingival Overgrowth Induced by Amlodipine and Cyclosporine
    • Authors: Tanay Chaubal; Ranjeet Bapat
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Tanay Chaubal, Ranjeet Bapat


      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.08.008
       
  • Kidney Diseases Associated With Alternative Complement Pathway
           Dysregulation and Potential Treatment Options
    • Authors: Prateek Sanghera; Mythili Ghanta; Fatih Ozay; Venkatesh K. Ariyamuthu; Bekir Tanriover
      Pages: 533 - 538
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Prateek Sanghera, Mythili Ghanta, Fatih Ozay, Venkatesh K. Ariyamuthu, Bekir Tanriover
      Atypical hemolytic uremic syndrome and C3 glomerulopathy (dense deposit disease and C3 glomerulonephritis) are characterized as inappropriate activation of the alternative complement pathway. Genetic mutations affecting the alternative complement pathway regulating proteins (complement factor H, I, membrane cofactor protein and complement factor H–related proteins) and triggers (such as infection, surgery, pregnancy and autoimmune disease flares) result in the clinical manifestation of these diseases. A decade ago, prognosis of these disease states was quite poor, with most patients developing end-stage renal disease. Furthermore, renal transplantation in these conditions was associated with poor outcomes due to graft loss to recurrent disease. Recent advances in targeted complement inhibitor therapy resulted in significant improvement in disease remission, renal recovery, health-related quality of life and allograft survival.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.03.024
       
  • Aortic Aneurysm in Takayasu Arteritis
    • Authors: Kun-Qi Yang; Xu Meng; Ying Zhang; Peng Fan; Lin-Ping Wang; Hui-Min Zhang; Hai-Ying Wu; Xiong-Jing Jiang; Jun Cai; Xian-Liang Zhou; Ru-Tai Hui; De-Yu Zheng; Li-Sheng Liu
      Pages: 539 - 547
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Kun-Qi Yang, Xu Meng, Ying Zhang, Peng Fan, Lin-Ping Wang, Hui-Min Zhang, Hai-Ying Wu, Xiong-Jing Jiang, Jun Cai, Xian-Liang Zhou, Ru-Tai Hui, De-Yu Zheng, Li-Sheng Liu
      Background Aortic aneurysm (AA) is a severe complication of Takayasu arteritis (TA). This study aimed to evaluate the prevalence, clinical and imaging features, management and long-term outcomes of AA in patients with TA. Materials and Methods A retrospective study was performed of TA patients with AA admitted to Fuwai Hospital from 1996-2015. Baseline clinical data and follow-up data of TA patients with AA were collected and analyzed. Results Thirty-nine (4.2%) of 934 patients with TA were identified with AA that was related to vasculitis. The mean age at disease onset was 31 ± 10 years, with a female-to-male ratio of 1.79:1. The ascending aorta was the most common site of the aneurysmal lesion (18, 33.3%), and the most frequent manifestations associated with AA were chest tightness (12, 30.8%) and shortness of breath (12, 30.8%), which were usually concomitant with aortic valve insufficiency. Involvement of multiple sites in AA was found in 8 patients (20.5%), and multiple AAs were found in 5 patients (12.8%). No significant difference was observed in clinical and imaging findings between sexes. Of 25 patients (64.1%) with a median 72-month follow-up, 1 patient suffered from heart failure owing to perivalvular leakage, and 1 patient died, possibly related to severe complications of the operation. Conclusions The prevalence of AA is relatively low in Chinese patients with TA. AA seems to develop more frequently in male patients with TA. Management should consider location and size of AA, complexity of vessel lesions and disease status. Long-term follow-up is indispensable.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.08.018
       
  • Elevated Serum Midkine in Patients With Acute Pancreatitis
    • Authors: Yao Li; Yongda Lu; Jiaqing Shen; Chunfang Xu
      Pages: 548 - 552
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Yao Li, Yongda Lu, Jiaqing Shen, Chunfang Xu
      Background Midkine (MK) is reported to be involved in the pathogenesis of numerous pathologies, but the expression of MK in acute pancreatitis (AP) has not been well studied and documented. Methods In this study, the temporal changes of serum MK were assessed in 97 patients with AP by enzyme-linked immunosorbent assay. Results The concentration of serum MK increased along with the severity of AP. Serum MK level increased more significantly in patients with organ failure than in those without organ failure. A more obvious elevation of serum MK level was also observed in patients with pancreatic necrosis. Conclusion Serum MK might be a useful marker in the clinical diagnosis of AP.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.07.010
       
  • Drug-Coated Balloon Versus Drug-Eluting Stent in Primary Percutaneous
           Coronary Intervention: A Feasibility Study
    • Authors: David Gobić; Vjekoslav Tomulić; Davorka Lulić; David Židan; Sandro Brusich; Tomislav Jakljević; Luka Zaputović
      Pages: 553 - 560
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): David Gobić, Vjekoslav Tomulić, Davorka Lulić, David Židan, Sandro Brusich, Tomislav Jakljević, Luka Zaputović
      Background Drug-eluting stents (DES) represent a significant evolution in the treatment of patients with acute myocardial infarction with ST elevation. However, stent-related adverse events have led to an introduction of drug-coated balloons (DCB) applied particularly to bifurcation lesions, in-stent restenosis and small vessel disease. The aim of this study was to determine whether a DCB-only strategy has a similar safety profile and equal angiographic and clinical outcomes to DES implantation in primary percutaneous coronary intervention (pPCI). Materials and Methods Seventy-five patients with acute myocardial infarction with ST elevation were randomized into DES and DCB groups of 37 and 38 patients, respectively. The study end-points were major adverse cardiac events and late lumen loss during the 6 months following the pPCI. Results Reinfarction occurred in 5.4% of patients in the DES and 5.3% of patients in the DCB group after 1 month (risk ratio = 1.03, 95% CI [0.15-6.91], P = 0.98). After 6 months, major adverse cardiac events were reported in 5.4% of patients in the DES group and none in the DCB group (risk ratio = 5.13, 95% CI [0.25-103.42], P = 0.29). Late lumen loss in the DES group was 0.10 ± 0.19mm and −0.09 ± 0.09mm in the DCB group (P < 0.05). Conclusions A DCB-only strategy is safe and feasible in the pPCI setting and showed good clinical and angiographic outcomes in a 6-month follow-up period.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.07.005
       
  • Socioeconomic, Psychosocial and Behavioral Characteristics of Patients
           Hospitalized With Cardiovascular Disease
    • Authors: Matthew E. Dupre; Alicia Nelson; Scott M. Lynch; Bradi B. Granger; Hanzhang Xu; Erik Churchill; Janese M. Willis; Lesley H. Curtis; Eric D. Peterson
      Pages: 565 - 572
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Matthew E. Dupre, Alicia Nelson, Scott M. Lynch, Bradi B. Granger, Hanzhang Xu, Erik Churchill, Janese M. Willis, Lesley H. Curtis, Eric D. Peterson
      Background Recent studies have drawn attention to nonclinical factors to better understand disparities in the development, treatment and prognosis of patients with cardiovascular disease. However, there has been limited research describing the nonclinical characteristics of patients hospitalized for cardiovascular care. Methods Data for this study come from 520 patients admitted to the Duke Heart Center from January 1, 2015 through January 10, 2017. Electronic medical records and a standardized survey administered before discharge were used to ascertain detailed information on patients' demographic (age, sex, race, marital status and living arrangement), socioeconomic (education, employment and health insurance), psychosocial (health literacy, health self-efficacy, social support, stress and depressive symptoms) and behavioral (smoking, drinking and medication adherence) attributes. Results Study participants were of a median age of 65 years, predominantly male (61.4%), non-Hispanic white (67.1%), hospitalized for 5.11 days and comparable to all patients admitted during this period. Results from the survey showed significant heterogeneity among patients in their demographic, socioeconomic and behavioral characteristics. We also found that the patients' levels of psychosocial risks and resources were significantly associated with many of these nonclinical characteristics. Patients who were older, women, nonwhite and unmarried had generally lower levels of health literacy, self-efficacy and social support, and higher levels of stress and depressive symptoms than their counterparts. Conclusions Patients hospitalized with cardiovascular disease have diverse nonclinical profiles that have important implications for targeting interventions. A better understanding of these characteristics will enhance the personalized delivery of care and improve outcomes in vulnerable patient groups.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.07.011
       
  • Assessing Mobile Health Capacity and Task Shifting Strategies to Improve
           Hypertension Among Ghanaian Stroke Survivors
    • Authors: Michelle Nichols; Fred Stephen Sarfo; Arti Singh; Suparna Qanungo; Frank Treiber; Bruce Ovbiagele; Raelle Saulson; Sachin Patel; Carolyn Jenkins
      Pages: 573 - 580
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Michelle Nichols, Fred Stephen Sarfo, Arti Singh, Suparna Qanungo, Frank Treiber, Bruce Ovbiagele, Raelle Saulson, Sachin Patel, Carolyn Jenkins
      Background There has been a tremendous surge in stroke prevalence in sub-Saharan Africa. Hypertension (HTN), the most potent, modifiable risk factor for stroke, is a particular challenge in sub-Saharan Africa. Culturally sensitive, efficacious HTN control programs that are timely and sustainable are needed, especially among stroke survivors. Mobile health (mHealth) technology and task-shifting offer promising approaches to address this need. Methods Using a concurrent triangulation design, we collected data from stroke survivors, caregivers, community leaders, clinicians and hospital personnel to explore the barriers, facilitators and perceptions toward mHealth related to HTN management among poststroke survivors in Ghana. Exploration included perceptions of a nurse-led navigational model to facilitate care delivery and willingness of stroke survivors and caregivers to use mHealth technology. Results Two hundred stroke survivors completed study surveys while focus groups (n = 4) were conducted with stroke survivors, caregivers and community leaders (n = 28). Key informant interviews were completed with clinicians and hospital personnel (n = 10). A total of 93% of survey respondents had HTN (60% uncontrolled). Findings support mHealth strategies for poststroke care delivery and HTN management and for task-shifting through a nurse-led model. Of survey and focus group participants, 76% and 78.6%, respectively, have access to mobile phones and 90% express comfort in using mobile phones and conveyed assurance that task-shifting through a nurse-led model could facilitate management of HTN. Findings also identified barriers to care delivery and medication adherence across all levels of the social ecological model. Conclusions Participants strongly supported enhanced care delivery through mobile health and were receptive toward a nurse-led navigational model.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.08.005
       
  • Using Ice Cream for Diagnosis of Diabetes Mellitus and Impaired Glucose
           Tolerance: An Alternative to the Oral Glucose Tolerance Test
    • Authors: Wandee Chanprasertpinyo; Nattapimon Bhirommuang; Titiporn Surawattanawiset; Thanwarin Tangsermwong; Pariya Phanachet; Chutintorn Sriphrapradang
      Pages: 581 - 585
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Wandee Chanprasertpinyo, Nattapimon Bhirommuang, Titiporn Surawattanawiset, Thanwarin Tangsermwong, Pariya Phanachet, Chutintorn Sriphrapradang
      Background Oral glucose tolerance test (OGTT) is a sensitive and reliable test for diabetes mellitus and impaired glucose tolerance (IGT). However, poor patient tolerance of glucose solutions is common. We aim to compare the diagnostic value of an ice cream test with a standard OGTT. Materials and Methods A total of 104 healthy adults were randomly assigned to either 75-g OGTT or ice cream, followed by a crossover to the other test. Results Most patients were females (71%). Mean age was 37 ± 12 years, and body mass index was 24.2 ± 3.9kg/m2. Diabetes mellitus and IGT, as diagnosed by 75-g OGTT, were 4.8% and 6.7%, respectively. The 2-hour plasma glucose levels were 110 ± 55.5mg/dL with 75-g glucose and 97.52 ± 40.7mg/dL with ice cream. The correlation coefficient of 2-hour plasma glucose for the 2 tests was 0.82 (95% CI: 0.75-0.87; P < 0.001). Discordant diagnostic results, based on 2-hour plasma glucose levels, were 9.61%. By using a combination of fasting plasma glucose and 2-hour plasma glucose values, the ice cream test would have missed 5.76% of those at high risk for diabetes mellitus (impaired fasting glucose and IGT) or diabetes. Conclusions An ice cream test may serve as an alternative to a 75-g OGTT. Before applying this test in clinical practice, it needs to be validated in a larger population.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.08.007
       
  • Combined Cryoballoon and Radiofrequency Ablation Versus Radiofrequency
           Ablation Alone for Long-Standing Persistent Atrial Fibrillation
    • Authors: Tümer Erdem Guler; Tolga Aksu; Kivanc Yalin; Sukriye Ebru Golcuk; Ferit Onur Mutluer; Serdar Bozyel
      Pages: 586 - 596
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Tümer Erdem Guler, Tolga Aksu, Kivanc Yalin, Sukriye Ebru Golcuk, Ferit Onur Mutluer, Serdar Bozyel
      Background To achieve sinus rhythm, ablation of long-standing persistent atrial fibrillation (LSPAF) usually requires substrate modification in addition to pulmonary vein isolation (PVI). In the present article, we aimed to compare clinical and substrate modification effects of 2 distinct PVI strategies during stepwise ablation in patients with LSPAF: (1) Combined approach: cryoballoon (CB) for PVI and radiofrequency (RF) ablation for substrate modification and (2) RF-only approach: RF ablation for both PVI and substrate modification. Materials and Methods A total of 34 patients were divided into 2 groups: 19 in the combined group and 15 in the RF group. Left atrial (LA) complex fractionated atrial electrogram (CFAE) maps were acquired before and after PVI and compared between groups. The groups were compared for acute atrial fibrillation termination (AFT) rates and long-term arrhythmia-free survival. Results A significant reduction on total LA CFAE area was observed with PVI in both groups. In the CB group, when pulmonary veins were excluded, the reduction of LA CFAE area was the most significant on the posterior wall of left atrium and which was greater than in the RF group. Although the ratio of AFT was higher in the CB group (44% versus 33%, respectively), single-procedure arrhythmia-free survival at 1 year was comparable between groups (68% in the CB group versus 66% in the RF group). Times of total procedure, fluoroscopy and post-PVI RF were all shorter in the CB group. Conclusions CB may cause greater substrate modification on the posterior wall and increase AFT rate during LSPAF ablation.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.08.010
       
  • Cross-Cultural Interprofessional Faculty Development in Japan: Results of
           an Integrated Workshop for Clinical Teachers
    • Authors: Jeffrey G. Wong; Daisuke Son; Wakako Miura
      Pages: 597 - 602
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Jeffrey G. Wong, Daisuke Son, Wakako Miura
      Background Faculty development programs, studied both home and abroad, have been shown to be helpful for enhancing the scholarly and academic work of nonacademic clinicians. Interprofessional education and faculty development efforts have been less well studied. This project investigated the effect of a well-studied faculty development program applied in an interprofessional fashion across health profession educators in medicine and nursing. Methods A faculty cohort of nurse and physician educators at The University of Tokyo underwent training in the Stanford Faculty Development Center (SFDC) model of clinical teaching through a sequence of 7 workshops. The workshops were performed in English with all materials translated into Japanese. A validated, retrospective pretest and posttest instrument was used to measure study outcomes on global assessment of teaching abilities and specific teaching behaviors (STBs) at 1 and 12 months after intervention. Successful completion of Commitment to Change statements were also assessed at 12 months. Results In total, 19 faculty participants completed the study. All participants found the workshops valuable. For global assessment, significant improvement in self-reported teaching abilities was seen comparing the mean pretest scores of 27.26 (maximum score = 55, standard deviation [SD] = 8.61) with mean scores at both 1 month (36.81, SD = 7.48, P < 0.001) and at 1 year (34.67, SD = 7.32, P < 0.001). For STBs, significant improvement was also seen comparing the mean group pretest score of 82.11 (maximum score = 145, SD = 15.72), to the posttest mean score of 111.11 (SD = 14.48, P < 0.001) and the 1-year mean score of 103.76 (SD = 12.87, P < 0.001). In total, 27/42 Commitment to Change statements were successfully completed at 1 year. Conclusions Faculty development for improving clinical teaching can be performed across the cultures of medicine and nursing, as well as across the cultures of the United States and Japan.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2016.09.007
       
  • Durability of Sirolimus for Lymphangioleiomyomatosis
    • Authors: Alexandra Martirossian; Shiwan Shah; Lola Carrete; Jose Valle; Vincent Valentine
      Pages: 603 - 607
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Alexandra Martirossian, Shiwan Shah, Lola Carrete, Jose Valle, Vincent Valentine
      Lymphangioleiomyomatosis (LAM), a rare, multisystem disorder primarily affecting women of reproductive age, is characterized by cystic-appearing lung lesions, progressive loss of lung function, chylous effusions and renal angiomyolipomas. Sirolimus, an mammalian target of rapamycin inhibitor, has been shown to stabilize lung function, reduce symptoms and resolve chylous effusions in the short term for patients with LAM. Herein, we report a premenopausal female with LAM who experienced complete and durable resolution of her chylothoraces with significant and sustained improvement in lung function on sirolimus.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2016.11.028
       
  • The Role of a Novel Long Noncoding RNA TUC40- in Cardiomyocyte Induction
           and Maturation in P19 Cells
    • Authors: Huijuan Li; Li Jiang; Zhangbin Yu; Shuping Han; Xuehua Liu; Mengmeng Li; Chun Zhu; Lixing Qiao; Li Huang
      Pages: 608 - 616
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Huijuan Li, Li Jiang, Zhangbin Yu, Shuping Han, Xuehua Liu, Mengmeng Li, Chun Zhu, Lixing Qiao, Li Huang
      Background In previous studies, TUC40-, a new long noncoding RNA, was found to be overexpressed in human ventricular septal defect (VSD) embryonic heart samples. In this article, we carried out experiments on the P19 cell line to elucidate the effects of TUC40- overexpression on cardiomyocyte development relevant to VSD pathogenesis. Methods We established the overexpression cell model by plasmid transfection, and explored the expression profile of Pbx1, the sense gene of TUC40-, and the marker genes of cardiomyocyte linage commitment (Nkx2.5 and GATA4) and maturation (cardiac troponin T). In addition, we combined cell cycle and Cell Counting Kit-8 analysis to detect cell proliferation and used flow cytometry and caspase-3 assays to test apoptosis. At last, bioinformatics analysis was performed to show the possible role of TUC40-. Results In the control group, Pbx1 elevated steadily during cardiomyocyte induction; whereas in the overexpression group, it showed significantly lower expression at day 6, 8 and 10 of induction. Cells in the overexpression group failed to induce cardiomyocytes indicated by GATA4 and cardiac troponin T. Proliferation was inhibited possibly owing to G2/M cell cycle arrest and the induced apoptosis rate was higher in the overexpression group. Conclusions TUC40- overexpression reduced Pbx1 expression, cardiomyocyte induction and differentiation, inhibited proliferation and promoted apoptosis. Combining the results and previous studies, we propose TUC40- as a potential pathologic factor for VSD.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.08.019
       
  • Ghrelin Ameliorates Asthma by Inhibiting Endoplasmic Reticulum Stress
    • Authors: Tian Fu; Lei Wang; Qingdi Zeng; Yan Zhang; Baowei Sheng; Liping Han
      Pages: 617 - 625
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Tian Fu, Lei Wang, Qingdi Zeng, Yan Zhang, Baowei Sheng, Liping Han
      Background This study aimed to confirm the ameliorative effect of ghrelin on asthma and investigate its mechanism. Materials and Methods The murine model of asthma was induced by ovalbumin (OVA) treatment and assessed by histological pathology and airway responsiveness to methacholine. The total and differential leukocytes were counted. Tumor necrosis factor α, interferon γ, interleukin-5 and interleukin-13 levels in bronchoalveolar lavage fluid were quantified by commercial kits. The protein levels in pulmonary tissues were measured by Western blot analysis. Results Ghrelin ameliorated the histological pathology and airway hyperresponsiveness in the OVA-induced asthmatic mouse model. Consistently, OVA-increased total and differential leukocytes and levels of tumor necrosis factor α, interferon γ, interleukin-5 and interleukin-13 in bronchoalveolar lavage fluid were significantly attenuated by ghrelin. Ghrelin prevented the increased protein levels of the endoplasmic reticulum stress markers glucose regulated protein 78 and CCAAT/enhancer binding protein homologous protein and reversed the reduced levels of p-Akt in asthmatic mice. Conclusions Ghrelin might prevent endoplasmic reticulum stress activation by stimulating the Akt signaling pathway, which attenuated inflammation and ameliorated asthma in mice. Ghrelin might be a new target for asthma therapy.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.08.022
       
  • Recurrent Malignancy-Associated Atypical Neutrophilic Dermatosis With
           Noninfectious Shock
    • Authors: Kathryn Nicole Kinser; Kamaldeep Panach; Arturo Ricardo Dominguez
      Pages: 626 - 632
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Kathryn Nicole Kinser, Kamaldeep Panach, Arturo Ricardo Dominguez
      Sweet syndrome (SS) or acute febrile neutrophilic dermatosis presents with the sudden onset of fever, leukocytosis and tender, erythematous, edematous, well-demarcated papules and plaques that histopathologically demonstrate a dense neutrophilic infiltrate. A total of 20% of patients with SS have malignancy-associated disease that can present with bullous or atypical skin lesions that mimic pyoderma gangrenosum, another neutrophilic dermatosis. Both entities exist on a spectrum, and in the context of underlying malignancy, these neutrophilic diseases become less clinically distinct. The literature also describes life-threatening cases of neutrophilic dermatoses that mimic severe sepsis. We present a fatal case of a patient with chronic eosinophilic leukemia with recurrent episodes of malignancy-associated atypical neutrophilic dermatosis characterized by necrotic skin lesions, pulmonary infiltrates and noninfectious shock and we also summarize the clinical presentations of an additional 10 patients reported in the literature. We conducted a PubMed search of articles published up to and in 2015, focusing on the English and Spanish literature with SS cross-referenced with the following search terms: neutrophilic dermatosis, pyoderma gangrenosum, shock, multiorgan failure and systemic inflammatory response syndrome. The articles were reviewed and the patients׳ clinical and laboratory findings were summarized. Cases of atypical neutrophilic dermatosis presenting with noninfectious shock syndrome are likely underrecognized clinically and underreported in the literature. Patients with malignancy-associated atypical neutrophilic dermatoses associated with noninfectious shock syndrome typically have multisystem disease characterized by recurrent episodes and typically have poor prognoses.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2016.10.003
       
  • Splenic Infarction and Rupture Due to Melioidosis
    • Authors: Deng-Wei Chou; Yie-Wen Lin
      Pages: 633 - 634
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Deng-Wei Chou, Yie-Wen Lin


      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2016.12.009
       
  • Nontyphoidal Salmonella Emphysematous Osteomyelitis
    • Authors: Deng-Wei Chou; Chao-Chin Yu
      Pages: 635 - 636
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Deng-Wei Chou, Chao-Chin Yu


      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2016.12.011
       
  • Extracellular Microvesicles as Game Changers in Better Understanding the
           
    • Authors: Mariusz Z. Ratajczak; Janina Ratajczak
      Pages: 449 - 452
      Abstract: Publication date: November 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 5
      Author(s): Mariusz Z. Ratajczak, Janina Ratajczak
      Recent research has led to wide acceptance and better understanding of a novel mechanism for cell-cell communication that employs a network of extracellular microvesicles (ExMVs). Derived from the plasma membrane or the endosomal membrane compartment, these small, spherical membrane fragments are secreted from the cell surface or in the process of exocytosis from endosomal membrane compartment and (1) with ligands expressed on their surface directly stimulate target cells in a paracrine manner, (2) transfer cell membrane receptors to target cells or (3) deliver encapsulated messenger RNA, microRNA, proteins and bioactive lipids to target cells. This represents an evolutionarily ancient mechanism by which cells signal their presence in the microenvironment, communicate with each other and affect the biology of neighboring cells. Evidence suggests the pivotal role of ExMVs in almost all biological processes within the body as well as their involvement in certain pathologies. Moreover, liquid biopsies based on deciphering the molecular signature of ExMVs promise to revolutionize laboratory diagnostics. At the same time, there are ongoing attempts to employ them as delivery vehicles for drugs as well as therapeutics in regenerative medicine, oncology and immunotherapy.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.06.001
       
  • Plasma Electrolyte Distributions in Humans—Normal or Skewed'
    • Authors: Mark Feldman; Beverly Dickson
      Pages: 453 - 457
      Abstract: Publication date: November 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 5
      Author(s): Mark Feldman, Beverly Dickson
      Background It is widely believed that plasma electrolyte levels are normally distributed. Statistical tests and calculations using plasma electrolyte data are often reported based on this assumption of normality. Examples include t tests, analysis of variance, correlations and confidence intervals. The purpose of our study was to determine whether plasma sodium (Na+), potassium (K+), chloride (Cl−) and bicarbonate ( HCO 3 − ) distributions are indeed normally distributed. Methods We analyzed plasma electrolyte data from 237 consecutive adults (137 women and 100 men) who had normal results on a standard basic metabolic panel which included plasma electrolyte measurements. The skewness of each distribution (as a measure of its asymmetry) was compared to the zero skewness of a normal (Gaussian) distribution. Results The plasma Na+ distribution was skewed slightly to the right, but the skew was not significantly different from zero skew. The plasma Cl− distribution was skewed slightly to the left, but again the skew was not significantly different from zero skew. On the contrary, both the plasma K+ and HCO 3 − distributions were significantly skewed to the right (P < 0.01 zero skew). There was also a suggestion from examining frequency distribution curves that K+ and HCO 3 − distributions were bimodal. Conclusions In adults with a normal basic metabolic panel, plasma potassium and bicarbonate levels are not normally distributed and may be bimodal. Thus, statistical methods to evaluate these 2 plasma electrolytes should be nonparametric tests and not parametric ones that require a normal distribution.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.07.012
       
  • Bedside Blood Glucose Monitoring in Critically Ill Patients: Comparison
           Between Arterial and Capillary Glucose
    • Authors: Xu Li; Yanquan Ma; Tianlu Chen; Jie Tang; Xiaochun Ma
      Pages: 458 - 461
      Abstract: Publication date: November 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 5
      Author(s): Xu Li, Yanquan Ma, Tianlu Chen, Jie Tang, Xiaochun Ma
      Background Critically ill patients are at high risk of hypoglycemia and are particularly vulnerable to unrecognized hypoglycemia. Close blood glucose monitoring is therefore crucial. There are several options to conduct frequent blood glucose measurement and a number of conditions in intensive care unit patients may affect the accuracy of blood glucose measurement. The aim of the study was to compare the accuracy of capillary glucose by bedside glucometer with arterial samples by bedside glucometer and arterial samples by blood gas analyzer in critically ill patients through a prospective case-control study. Materials and Methods Arterial and capillary samples from 60 patients were taken simultaneously and were tested immediately at the bedside. Results of the paired measurements were compared and expressed as a correlation coefficient. Results Capillary glucose in the study group and control group were 9.73 ± 2.28mmol/L and 8.9 ± 1.86mmol/L, respectively; mean arterial glucose measured by glucometer in the study group and control group were 9.25 ± 2.05mmol/L and 8.4 ± 1.89mmol/L, respectively; and mean arterial glucose measured by blood gas analyzer in the study group and control group were 8.41 ± 1.9mmol/L and 8.24 ± 1.5mmol/L, respectively. Correlation between capillary values and arterial values measured by glucometer was less in the study group (r = 0.936, P < 0.001 and r = 0.973, P < 0.001). Correlation between capillary values measured by glucometer and arterial values measured by blood gas analyzer was also less in the study group (r = 0.897, P = 0.001 and r = 0.964, P < 0.001). Conclusions Capillary blood glucose monitoring is reliable only in a selected group of critically ill patients.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.05.005
       
  • Contrast-Induced Nephropathy After Cardiac Catheterization: Culprits,
           Consequences and Predictors
    • Authors: Yub Raj Sedhai; Reshma Golamari; Santosh Timalsina; Soney Basnyat; Ajay Koirala; Ankush Asija; Tatvam Choksi; Akanksha Kushwah; David Geovorgyan; Tawseef Dar; Madhura Borikar; Waseem Ahangar; Joseph Alukal; Subtain Zia; Jose Missri
      Pages: 462 - 466
      Abstract: Publication date: November 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 5
      Author(s): Yub Raj Sedhai, Reshma Golamari, Santosh Timalsina, Soney Basnyat, Ajay Koirala, Ankush Asija, Tatvam Choksi, Akanksha Kushwah, David Geovorgyan, Tawseef Dar, Madhura Borikar, Waseem Ahangar, Joseph Alukal, Subtain Zia, Jose Missri
      Background Contrast-induced nephropathy (CIN) is a common complication after radiocontrast exposure. Methods A retrospective medical record review of 513 hospitalized patients who underwent cardiac catheterization from June-December 2014 was done, of which 38 patients with end-stage renal disease and 57 patients without preprocedural creatinine were excluded. Serum creatinine concentration before the procedure and each day for 3 days after the procedure was recorded. CIN was defined as an increase in serum creatinine concentration by ≥25% or ≥0.5mg/dL from the preprocedural value within 72hours of contrast exposure. Results A total of 418 patients (mean age: 69.1 ± 13.8 years, 55% males) were included in the study. Mean incidence of CIN was 3.7% (n = 16). CIN accounted for longer duration of hospitalization, lengthier intensive care unit admission, requirement of hemodialysis and higher mortality. Incidence of CIN was higher in the presence of preexisting atrial fibrillation (AF), congestive heart failure (CHF) and chronic kidney disease (CKD). When tested by univariate analysis, incidence of CIN was 13.8% in the AF group (P < 0.001), 8.6% in CHF group (P < 0.01) and 8.9% in CKD group (P < 0.002), compared with 2.3%, 1.9% and 2.4% in the absence of preexisting AF, CHF and CKD, respectively. On further testing using multivariate logistic regression model using AF, CHF and CKD as independent variables, development of CIN was strongly associated with preexisting AF with an odds ratio of 4.11, 95% CI: 1.40-12.07, P = 0.01. Conclusion Identifying patients at risk is an important step in preventing CIN. Preexisting AF, independent of traditional risk factors, may increase the risk for CIN.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.05.010
       
  • Ischemia Modified Albumin Test to Detect Early Diabetic Complications
    • Authors: Kinjalka Ghosh; Manohar G. Muddeshwar; Kanjaksha Ghosh
      Pages: 467 - 470
      Abstract: Publication date: November 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 5
      Author(s): Kinjalka Ghosh, Manohar G. Muddeshwar, Kanjaksha Ghosh
      Background The objective of this study was to assess the albumin cobalt binding (ACB) test in a cohort of type 2 diabetes patients. The ACB test is a simple, inexpensive, sensitive and robust test that could have important clinical application in detecting complications of type 2 diabetes mellitus. Materials and Methods We tested patients with type 2 diabetes without any clinically detectable complications or without any other comorbid conditions for serum ACB levels along with an equal number of age- and sex-matched healthy control subjects. ACB levels were compared after the patients with diabetes were investigated for various complications using standard statistical tests of significance. Results A total of 100 patients with type 2 diabetes were studied with age- and sex-matched healthy control subjects. Of the 100 patients, 78 had different complications on detailed laboratory testing. The patients with complications had significantly higher ACB test results when compared to the patients with diabetes without complications and to that of the control subjects (0.62 ± 0.04, 0.42 ± 0.07, 0.30 ± 0.05absorbance units (ABSU)/mL, respectively. P < 0.001). All values in diabetics were significantly higher than that of controls. Conclusions The serum ACB test is a sensitive indicator of complications developed in type 2 diabetes mellitus. Patients may be followed up with ACB results to detect early complications in this disease.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.06.017
       
  • Bacterial Etiology of Lower Respiratory Tract Infections and Their
           Antimicrobial Susceptibility
    • Authors: Maduakor Uzoamaka; Onyemelukwe Ngozi; Ogboi Sonny Johnbull; Ohanu Martin
      Pages: 471 - 475
      Abstract: Publication date: November 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 5
      Author(s): Maduakor Uzoamaka, Onyemelukwe Ngozi, Ogboi Sonny Johnbull, Ohanu Martin
      Background Lower respiratory tract infection (LRTI) is one of the common major health problems in Nigeria causing morbidity and mortality. The study was conducted to determine the current trends of bacterial etiology of LRTIs among patients who attended the University of Nigeria Teaching Hospital (UNTH) and their antimicrobial susceptibility profile with special interest on pandrug resistance. Materials and Methods The study was conducted between February 2014 and June 2016 in the bacteriology laboratory of UNTH. Sputum samples of 954 patients with suspected LRTIs were received, after obtaining patients’ informed consent and ethical clearance from the UNTH. The samples were collected and processed according to standard laboratory procedures. Results The mean age of the patients was 42.6 ± 16.8 years. Of the total 954 sputum samples, 431 (45.2%) were positive for micro-organisms. A single, unique pathogen was recovered in 415 patients (96.3%), and 16 (3.7%) were polymicrobial. The most predominant single pathogen was Klebsiella pneumoniae, 215 (49.9%), and the most prevalent bacterial combination was Klebsiella spp and Pseudomonas aeruginosa, 6 (1.4%). Antimicrobial susceptibility testing shows that most isolates of K pneumoniae were susceptible to imipenem (94.8%). Among the bacteria, Escherichia coli (13.3%) ranked highest, followed by P aeruginosa (12.5%), and the least was Staphylococcus aureus (2.1%). Conclusions Knowledge of the diversity of pathogens responsible for LRTIs and their susceptibility patterns to antibiotics, as well as antibiotic resistance surveillance, are important in the effective management of LRTI with prompt clinical and laboratory diagnosis along with appropriate treatment strategies.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.06.025
       
  • Combined Assessment of Relaxin and B-Type Natriuretic Peptide Improves
           Diagnostic Value in Patients With Congestive Heart Failure
    • Authors: Ling Han; Jingguang Luo; Shanshan Bai; Ye Jia; Xin Chen; Yan Zhao; Liwei Chen; Xiaogang Zhu; Ying Li; Yuanyuan Jiang; Xiaohong Li; Ming Yang; Dongxia Li; Xu Teng; Yongfen Qi
      Pages: 480 - 485
      Abstract: Publication date: November 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 5
      Author(s): Ling Han, Jingguang Luo, Shanshan Bai, Ye Jia, Xin Chen, Yan Zhao, Liwei Chen, Xiaogang Zhu, Ying Li, Yuanyuan Jiang, Xiaohong Li, Ming Yang, Dongxia Li, Xu Teng, Yongfen Qi
      Background To improve the poor prognosis of congestive heart failure (CHF), early and accurate diagnosis is necessary. Relaxin is an endogenous cardiovascular peptide, and its plasma level is usually increased in patients with CHF. In this pilot study, we aimed to determine the diagnostic value of relaxin and B-type natriuretic peptide (BNP) in patients with and without CHF. Materials and Methods The plasma level of relaxin was measured by enzyme-linked immunosorbent assay and plasma level of BNP by fluorescence immunoassay. The area under the receiver operating characteristic curve was used to assess the diagnostic value of relaxin and BNP. Results We included 81 patients with decompenstated CHF and 36 controls. Plasma levels of relaxin and BNP were both higher in CHF patients than in controls. The correlation between plasma levels of relaxin and BNP and between relaxin or BNP and cardiac function was nonlinear. Relaxin had medium diagnostic value, and BNP had higher value for cardiac function and CHF. At a cutoff of 39.76pg/mL relaxin, sensitivity was 82.7%, specificity 55.6%, sum of the highest positive predictive value 80.5% and negative predictive value 58.8%. Although the diagnostic value was not better for relaxin than BNP, their combined assessment improved the sensitivity and specificity of diagnosis for CHF as compared with BNP alone. Conclusions Combined assessment of relaxin and BNP may improve the diagnosis of decompensated CHF, which may have potential application in the clinic.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.07.002
       
  • Sporadic Fundic Gland Polyps and Gastric Acid Suppression Level
    • Authors: Mohamed H. Khalaf; Andrew Brock; Donald O. Castell
      Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6
      Author(s): Mohamed Khalaf, Andrew S. Brock, Donald Castell
      Background Fundic gland polyps (FGPs) are a common endoscopic finding and are known to be associated with proton pump inhibitors (PPIs) use. It is not known if their prevalence is affected by gastric acidity levels. This study aimed to assess whether there is a correlation between FGPs and gastric acidity levels as identified on 24-hour ambulatory impedance-pH studies in patients on PPI therapy. Methods We performed a review of 402 consecutive patients who take at least once daily PPI and underwent esophagogastroduodenoscopy with combined impedance-pH studies in the same setting (time and place) between January 2010 and December 2014. Patients were classified into 2 groups based on the presence or absence of biopsy-confirmed FGPs during endoscopy. Results Of the 402 patients, 30 (7%) had FGPs. One of these polyps was found with low-grade dysplasia. There was no significant difference of the distributions of the [H+] in the FGPs versus the nonpolyp groups (P = 0.741). There was no significant difference between the 2 groups regarding PPI dose frequency regimens (once and twice) (P = 0.074). However, we found weak ordinal association with PPI duration (P = 0.01) (Spearman = 0.1). Conclusions FGPs are common endoscopic lesions. Incidence of dysplasia in FGPs is not only rare, but also of unknown clinical significance. Although they seem to be associated with PPIs, the mechanism remains unclear, as we found no correlation between the presence of FGPs and gastric acid control or PPI dose. Future studies would be useful to elucidate an alternate mechanism.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/s0016-5085(17)31767-5
       
  • Clinical Characteristics and Efficacy of Radiofrequency Catheter Ablation
           in the Treatment of Elderly Patients with Atrial Fibrillation
    • Authors: Xin-Yong Zhang; Rong-Hui Yu; Jian-Zheng Dong
      Abstract: Publication date: Available online 9 December 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Xin-Yong Zhang, Rong-Hui Yu, Jian-Zheng Dong
      Objective This study aims to investigate the clinical characteristics and therapeutic effect of radiofrequency catheter ablation (RFCA) in elderly patients with atrial fibrillation (AF). Methods This retrospective study included 668 patients with AF who underwent RFCA in our hospital from June 2010 to June 2015. Patients were divided into 2 groups according to age: group E (≥60 years old, n=308) and group N (<60 years old, n=360). Ablation endpoints included the following 3 points: (1) all preset ablation lines were completed; (2) all pulmonary veins were electrically isolated; and (3) negative evoked results were achieved. The success of follow-up was defined as patients who did not have an atrial arrhythmia attack for at least 3 months without the administration of anti-arrhythmia drugs. Results Clinical characteristics of elderly patients with AF: the proportion accounted for by female patients with AF, patients with hypertension and patients with a CHADS2 score ≥2 points was significantly higher than that in group N (P<0.001). RFCA procedure and safety: differences in the success rate of the first operation and severe complications were not statistically significant (P>0.05). Postoperative follow-up: the follow-up period was between 6–12 months after operation. Differences in the proportion of patients with repeated ablation and total success rate were not statistically significant (P>0.05). Conclusion Although elderly patients with AF had more clinical complications, no differences in the success rate of RFCA and postoperative complications between the 2 groups were found. RFCA is a safe and effective treatment for elderly patients with AF.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.12.002
       
  • Using Both Lactic Dehydrogenase Levels and the Ratio of Involved to
           Uninvolved Free Light Chain Levels as Risk Factors Improves Risk
           Assessment in Patients with Newly Diagnosed Multiple Myeloma
    • Authors: Zihua Guo; Huijun Li; Yudi Geng; Jian Cui; Ning Tang; Dengju Li
      Abstract: Publication date: Available online 9 December 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Zihua Guo, Huijun Li, Yudi Geng, Jian Cui, Ning Tang, Dengju Li
      Background This study aimed to evaluate the prognostic value of the ratio of involved to uninvolved free light chain (rFLC) levels and lactic dehydrogenase (LDH) levels in the risk stratification of multiple myeloma (MM) patients. Materials and Methods Clinical data of 283 patients with newly diagnosed MM were retrospectively analyzed. Results In the traditional chemotherapy group, patients with an rFLC < 100 had a better prognosis than those with an rFLC ≥ 100 (40 months vs. 6 months, p = 0.022), as did patients with an LDH ≤ upper limit of normal(ULN) compared to those with an LDH > ULN (29 months vs. 6 months, p = 0.023). In patients who underwent novel drug-combined therapy, no significant difference was observed between the rFLC < 100 group and the rFLC ≥ 100 group (54 months vs. median not reached, p = 0.508). However, patients with an LDH ≤ ULN had a better prognosis than those with an LDH > ULN (60 months vs. 21 months, p = 0.004). Using an rFLC ≥ 100 and an LDH ≥ ULN as adverse risk factors, patients were classified into 3 groups: group 1 (no adverse risk factors), group 2 (1 adverse risk factor), and group 3 (2 adverse risk factors). The median overall survival (OS) of groups 1, 2, and 3 was 52 months, 34 months and 15 months, respectively (p = 0.001). Conclusions rFLC and LDH levels were sensitive prognostic factors in MM patients, combining them could improve the risk stratification and treatment choice of patients in clinical practice.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.12.003
       
  • Association between Metabolic Syndrome and Micro- and Macrovascular
           disease in Type 2 Diabetic Mellitus
    • Authors: Mei-Yueh Lee; Pi-Jung Hsiao; Jiun-Chi Huang; Wei-Hao Hsu; Szu-Chia Chen; Shyi–Jang Shin
      Abstract: Publication date: Available online 9 December 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Mei-Yueh Lee, Pi-Jung Hsiao, Jiun-Chi Huang, Wei-Hao Hsu, Szu-Chia Chen, Shyi–Jang Shin
      Background The prevalence of metabolic syndrome (MetS) in patients with type 2 diabetes mellitus is high. The aim of this study was to investigate the association between MetS and micro- and macrovascular disease in patients with diabetes, and the associated risk factors. Methods The study enrolled 1,986 (854 men and 1,132 women) patients with type 2 diabetes mellitus from outpatient clinics. MetS was defined according to the Adult Treatment Panel III for Asians. Results Of the enrolled patients, 1,363 had MetS and 623 did not. The patients with MetS had significantly higher rates of albuminuria (40.8% vs. 21.8%, p < 0.001), retinopathy (37.9% vs. 28.6%, p < 0.001), coronary artery disease (19.4% vs. 11.6%, p < 0.001), cerebrovascular disease (5.8% vs. 3.2%, p = 0.014), and an ankle-brachial index < 0.9 or ≥ 1.3 (6.1% vs. 3.0%, p = 0.015). Moreover, there were significant trends for stepwise increases in albuminuria, retinopathy, coronary artery disease, cerebrovascular disease and peripheral artery disease corresponding to the number of MetS components (all p for trend < 0.05). Risk factors including MetS, old age, sex, wide pulse pressure, increased hemoglobin A1c, dyslipidemia and decline renal function were associated with micro- and macrovascular disease. Conclusions MetS and the number of its components were significantly associated with micro- and macrovascular disease in the study patients with diabetes, and this resulted in a higher risk of cardiovascular disease. Screening programs to allow for early detection and interventions should be established to lower the risk of cardiovascular disease.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.12.004
       
  • Comparison of Clinical Practice in the Emergency Department: Female versus
           Male Emergency Physicians
    • Authors: Kuo-Chen Huang; Yan-Ren Lin; Yuan-Jhen Syue; Chia-Te Kung; I-Min Chiu; Chao-Jui Li
      Abstract: Publication date: Available online 6 December 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Kuo-Chen Huang, Yan-Ren Lin, Yuan-Jhen Syue, Chia-Te Kung, I-Min Chiu, Chao-Jui Li
      Background There are fewer female emergency physicians (Eps) than male ones. This study attempted to analyze the differences in clinical practice between female and male EPs in the emergency department (ED). Materials and Methods A retrospective, 1-year cohort study was conducted across 4 EDs in the largest healthcare system in Taiwan. A total of 199,757 adult patients without trauma treated by 76 EPs (9 female and 67 male) were included in the study. The clinical practice of female and male EPs was compared. The door-to-order and door-to-disposition times were used to evaluate EP efficiency. Indicators of diagnostic tool use included laboratory examinations and computed tomography (CT) scans. Patient dispositions included discharge, ED observation, general ward and intensive care unit admissions, and ED mortality rate. Disposition accuracy was evaluated by determining the 72-hour ED revisit rate. Result The clinical practice of female and male EPs was similar. After adjusting for the potential confounding factors through a regression model, female EPs showed slight increase in laboratory examination use (adjusted odds ratio [aOR], 1.05; 95% confidence interval [CI], 1.01–1.09) compared with male EPs, but no difference in CT use was observed between sexes. Additionally, no differences among patient dispositions and 72-hour ED revisit rates (aOR, 1.0; 95% CI, 0.93–1.06) were observed between female and male EPs. Conclusion Female and male EPs had similar clinical efficiency on patient evaluation, and they had no difference in diagnostic tool use. Furthermore, they showed similar patient disposition with the same accuracy.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.12.001
       
  • Pyrvinium Sensitizes Clear Cell Renal Cell Carcinoma Response to
           Chemotherapy Via Casein Kinase 1α-Dependent Inhibition of Wnt/ β-Catenin
           
    • Authors: Long Cui; Juan Zhao; Jingjing Liu
      Abstract: Publication date: Available online 2 December 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Long Cui, Juan Zhao, Jingjing Liu
      Background Aberrant Wnt/β-catenin activation has been shown to play essential roles in cancer, including renal cell carcinoma (RCC). In this work, we demonstrate that Wnt/β-catenin inhibition by a FDA-approved drug, pyrvinium, effectively targets clear cell RCC and enhances chemotherapy agent′s efficacy. Materials and Methods We performed in vitro cell culture assays and in vivo xenograft tumor model to evaluate the effects of pyrvinium alone and its combination with paclitaxel, and analyzed the underlying mechanism(s) of pyrvinium′s action in RCC. Results We show that pyrvinium inhibits growth and induces apoptosis via caspase pathway in a panel of RCC cell lines. It decreases β-catenin activity and its downstream Wnt-targeted genes transcription via Axin-mediated β-catenin protein reduction. Overexpression of β-catenin completely reverses the effects of pyrvinium, demonstrating that β-catenin inhibition is required for pyrvinium′s action in clear cell RCC. Furthermore, we found that pyrvinium failed to decrease β-catenin protein level and activity in casein kinase 1α (CK1α)-depleted clear cell RCC cells, demonstrating that pyrvinium inhibits β-catenin in a CK1α-dependent manner. Notably, decreased tumor growth and β-catenin levels were observed in clear cell RCC xenograft mouse model treated with pyrvinium. Combination of pyrvinium and paclitaxel resulted in greater efficacy in in vitro and in vivo. Conclusions Our findings suggest that pyrvinium is a useful addition to the treatment armamentarium for clear cell RCC. Our work also demonstrate that targeting Wnt/ β-catenin is a potential therapeutic strategy in clear cell RCC.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.11.017
       
  • Acknowledgment of Reviewers
    • Abstract: Publication date: December 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 6


      PubDate: 2017-12-12T09:31:01Z
       
  • Catheter ablation of bradyarrhythmia: From the beginning to the future
    • Authors: Tolga Aksu; Tumer Erdem Guler; Kivanc Yalin; Ferit Onur Mutluer; Kazim Serhan Ozcan; Leonardo Calò
      Abstract: Publication date: Available online 1 December 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Tolga Aksu, Tumer Erdem Guler, Kivanc Yalin, Ferit Onur Mutluer, Kazim Serhan Ozcan, Leonardo Calò
      Enhanced parasympathetic tone may cause sinus bradycardia or pauses, transient or permanent atrioventricular block, with resultant vasovagal syncope. A substantial portion of these patients may be highly symptomatic and refractory to the conventional therapies and may require cardiac pacemaker implantation. Cardioneuroablation (CNA) is a little known technique for management of patients with excessive vagal activation based on radiofrequency catheter ablation of main parasympathetic autonomic ganglia around the heart. Due to complicated inclusion criteria, ganglia detection methods, and ablation endpoints, routine usage of the procedure cannot be recommended at this time. In this comprehensive review, we aimed to discuss all aspects of CNA procedure in bradyarrhythmias.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.11.016
       
  • DASS21: A useful tool in the psychological profile evaluation of dialysis
           patients
    • Authors: Wen Jiun Liu; Ramli Musa; Thian Fook Chew; Christopher Thiam Seong Lim; Zaki Morad; Adam Bin Mohamad Bujang
      Abstract: Publication date: Available online 1 December 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Wen Jiun Liu, Ramli Musa, Thian Fook Chew, Christopher Thiam Seong Lim, Zaki Morad, Adam Bin Mohamad Bujang
      Background The impact of dialysis treatment is complex with both clinical and socio-psychological effects. In this study, we aimed to assess the psychological status of this growing population of end-stage renal disease. Methods Using the Short Form of Depression, Anxiety, and Stress Scale (DASS21) questionnaire, we aimed 1) to measure the psychological states of hemodialysis (HD) or peritoneal dialysis (PD) subjects from 15 sites, 2) to compare DASS21 scores between HD and PD 3) to identify the associated demographic and medical factors of better psychological states. Results 1,332 were eligible for analysis. Stress (48%) recorded the highest negative emotional states followed by depression (37%) and anxiety (20%). By multivariate analysis, normal BMI weight status, religion, and absence of coronary artery disease (CAD) were associated with lower score for depression, anxiety, and stress, respectively. Tertiary education was associated with the lowest score in depression and anxiety, while HD had a lower score in stress than PD. A younger age was associated with worse DASS21 score of anxiety and stress. Conclusions Obesity, religion, and CAD were significantly associated with all 3 symptoms of depression, anxiety, and stress. Older age has a protective effect on anxiety and stress. Further study is needed to evaluate the relationship between these significant factors and each psychological state.

      PubDate: 2017-12-12T09:31:01Z
      DOI: 10.1016/j.amjms.2017.11.015
       
  • Microparticles in Hematological Malignancies – their Role in
           Coagulopathy and Tumor Pathogenesis
    • Authors: Somedeb Ball; Kenneth Nugent
      Abstract: Publication date: Available online 28 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Somedeb Ball, Kenneth Nugent
      Microparticles (MP) are submicron vesicles released from various cells in response to activation, injury, or apoptosis. They contain different structural and functional proteins and RNAs, which contribute to physiological intercellular “crosstalk” and to the pathogenesis of various diseases including cancer. In hematological malignancies, these microparticles participate in the initiation and propagation of thrombosis through different pathways. They have a role in the angiogenesis, malignant cell survival, and metastasis. Microparticles act as a mediator of resistance of leukemic cells to chemotherapy. The number of MPs is one of the prognostic factors following stem cell transplant, and studies have also found they contribute to the pathogenesis of graft versus host disease (GVHD). Microparticles are being tested as therapeutic options in leukemias and GVHD. Future studies should help us understand the interactions between MPs and cancer cells better, thereby opening new approaches for treatment of hematological malignancies.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.11.014
       
  • Evaluation and Management of Gross Hematuria in Autosomal Dominant
           Polycystic Kidney Disease: A Point of Care Guide for Practicing Internists
           
    • Authors: Bhavna Bhasin; Mohammed Alzubaidi; Juan Carlos Q. Velez
      Abstract: Publication date: Available online 28 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Bhavna Bhasin, Mohammed Alzubaidi, Juan Carlos Q. Velez
      Gross 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.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.11.013
       
  • The First Reported Case of Cytomegalovirus Gastritis in a Patient with
           End-Stage Renal Disease
    • Authors: Chi-Hao Liu; An-Hang Yang; Shuo-Ming Ou; Der-Cherng Tarng
      Abstract: Publication date: Available online 23 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Chi-Hao Liu, An-Hang Yang, Shuo-Ming Ou, Der-Cherng Tarng
      Cytomegalovirus (CMV) infection is a common infectious complication in immunocompromised patients. The colon is the most common site of CMV infection in the gastrointestinal tract. Rarely, however, invasion of the upper gastrointestinal tract, such as the esophagus or stomach, has been reported. Herein, we describe the first reported case of CMV gastritis in a patient with end-stage renal disease (ESRD) and uremic symptoms (including nausea, vomiting, and poor appetite) who had begun hemodialysis therapy. This patient was not a transplant recipient and was not receiving immunosuppressant treatment. As CMV gastritis is easily overlooked in patients with ESRD, physicians should maintain a high index of suspicion and establish the diagnosis as early as possible using an upper GI endoscopic biopsy and adequate staining.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.11.012
       
  • Local Anesthetic Drug Inhibits Growth and Survival in Chronic Myeloid
           Leukemia Through Suppressing PI3K/Akt/mTOR
    • Authors: Qinghong Zheng; Xiaohong Peng; Hai Yu
      Abstract: Publication date: Available online 22 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Qinghong Zheng, Xiaohong Peng, Hai Yu
      Background Apart from the known anesthetic and antiarrhythmic effects, recent studies also highlight the anti-cancer activities of local anesthetics. In lines with the findings, our work show that ropivacaine, a mide-linked local anesthetic drug, targets chronic myeloid leukemia (CML) via inhibiting PI3K/Akt/mTOR. Materials and Methods The effects of ropivacaine in CML cell lines and primary stem or progenitor cells were investigated using apoptosis, proliferation and colony formation assays. The effects of ropivacaine on proliferation and survival pathways were analysed using Western Blot. Results We demonstrate that ropivacaine dose- and time-dependently inhibits proliferation in CML cell lines via arresting cell at G2/M stage. Ropivacaine induces apoptosis in CML cells. In addition, the anti-CML activity of ropivacaine is mainly through growth arrest rather than apoptosis induction. We further demonstrate that ropivacaine induces apoptosis and inhibits colony formation in CD34 progenitor or stem cells derived from patients with blast phase (BP)-CML. Importantly, combination of ropivacaine with imatinib or dasatinib (Bcr-Abl tyrosine kinase inhibitors) is significantly more effective in targeting CML cell lines as well as BP-CML CD34 cells than imatinib or dasatinib alone. We further demonstrate that ropivacaine inhibits phosphorylation of essential molecules involved in PI3K/Akt/mTOR signaling pathways in CML cells. Akt overexpression significantly reverses the effects of ropivacaine, further confirming that ropivacaine acts on CML cells via inhibition of PI3K/Akt/mTOR. Conclusions Our work provide rationales on clinical trials for the use of local anesthetics in CML by demonstrating the anti-CML effects of ropivacaine and the molecular mechanism of its action.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.11.011
       
  • A Man who Harvest Peanuts with Verrucous Lesions in his Right Index Finger
    • Authors: Carlos Franco-Paredes; Swati Mathur; Wilmer Villamil-Gomez; Andrés F. Henao-Martínez
      Abstract: Publication date: Available online 22 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Carlos Franco-Paredes, Swati Mathur, Wilmer Villamil-Gomez, Andrés F. Henao-Martínez


      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.11.010
       
  • Assessing Guideline-Directed Therapy for Heart Failure in End-Stage Renal
           Disease
    • Authors: B. Tate Cutshall; Benjamin T. Duhart; Jagannath Saikumar; Michael Samarin; Lydia Hutchison; Joanna Q. Hudson
      Abstract: Publication date: Available online 21 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): B. Tate Cutshall, Benjamin T. Duhart, Jagannath Saikumar, Michael Samarin, Lydia Hutchison, Joanna Q. Hudson
      Background Treatment of heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medication therapy (GDMT) consisting of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in combination with an indicated beta-blocker. There is concern that end-stage renal disease (ESRD) patients are not being prescribed GDMT. The study aim was to determine if outcomes differ for patients with HFrEF and ESRD receiving GDMT compared to those not receiving GDMT. Methods Adult patients with ESRD and HFrEF admitted to a tertiary, teaching hospital over a 2-year period were included. Patients were categorized into GDMT or non-GDMT groups based on their home medications. The length of stay (LOS), mortality, and 30-day hospital readmissions were compared between groups. The incidence of hyperkalemia, hypotension, and bradycardia were also evaluated. Results 109 patients were included: 88% black, 61% male, median age 63 (28–93) years with 25 in the GDMT group and 84 in the non-GDMT group. The LOS did not differ between the GDMT (5 days; 3–14) compared to the non-GDMT group (7 days; 3–28), p=0.14. Thirty-day hospital readmission and in-hospital mortality were also similar. Hypotension occurred less frequently in the GDMT group compared to non-GDMT group, 4% vs 27% (p=0.01). Conclusions While there were no differences in the primary outcomes, the shorter LOS in the GDMT group may be clinically significant. The fact that the majority of patients with ESRD and HFrEF were not receiving GDMT is a finding that may require further evaluation.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.11.008
       
  • The Association Between Major Depressive Disorder and Outcomes in Older
           Veterans Hospitalized With Pneumonia
    • Authors: Ami L. DeWaters; Matthieu Chansard; Antonio Anzueto; Mary Jo Pugh; Eric M. Mortensen
      Abstract: Publication date: Available online 20 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Ami L. DeWaters, Matthieu Chansard, Antonio Anzueto, Mary Jo Pugh, Eric M. Mortensen
      Background Major depressive disorder (“depression”) has been identified as an independent risk factor for mortality for many comorbid conditions, including heart failure, cancer and stroke. Major depressive disorder has also been linked to immune suppression by generating a chronic inflammatory state. However, the association between major depression and pneumonia has not been examined. The aim of this study was to examine the association between depression and outcomes, including mortality and intensive care unit admission, in Veterans hospitalized with pneumonia. Materials and Methods We conducted a retrospective national study using administrative data of patients hospitalized at any Veterans Administration acute care hospital. We included patients ≥65 years old hospitalized with pneumonia from 2002-2012. Depressed patients were further analyzed based on whether they were receiving medications to treat depression. We used generalized linear mixed effect models to examine the association of depression with the outcomes of interest after controlling for potential confounders. Results Patients with depression had a significantly higher 90-day mortality (odds ratio 1.12, 95% confidence interval 1.07-1.17) compared to patients without depression. Patients with untreated depression had a significantly higher 30-day (1.11, 1.04-1.20) and 90-day (1.20, 1.13-1.28) mortality, as well as significantly higher intensive care unit admission rates (1.12, 1.03-1.21), compared to patients with treated depression. Conclusion For older veterans hospitalized with pneumonia, a concurrent diagnosis of major depressive disorder, and especially untreated depression, was associated with higher mortality. This highlights that untreated major depressive disorder is an independent risk factor for mortality for patients with pneumonia.

      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.08.015
       
  • The Troubled Spirit of Abraham Flexner
    • Authors: Anthony D. Weaver
      Abstract: Publication date: Available online 16 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Anthony D. Weaver


      PubDate: 2017-12-01T06:31:23Z
      DOI: 10.1016/j.amjms.2017.11.005
       
  • The Association of ADRB1 and CYP2D6 Polymorphisms with Antihypertensive
           Effects and Analysis of Their Contribution to Hypertension Risk
    • Authors: Liping Chen; Ting Xiao; Liling Chen; Shanshan Xie; Maoqing Deng; Dingchang Wu
      Abstract: Publication date: Available online 13 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Liping Chen, Ting Xiao, Liling Chen, Shanshan Xie, Maoqing Deng, Dingchang Wu
      Background Genetic factors have a vital influence on the pathogenesis of hypertension. In this retrospective study, we aimed to evaluate the association of ADRB1 and CYP2D6 polymorphisms with antihypertensive effects and perform an analysis of their contribution to hypertension risk. Methods A total of 261 healthy individuals and 261 essential hypertension (EH) patients treated with metoprolol for 12 weeks were enrolled. ADRB1 and CYP2D6 genotypes were identified by xTAG® liquid chip technology. We used multivariate logistic regression and a generalized linear mixed model to assess hypertension-related risk factors. Results The allele frequencies of ADRB1 and CYP2D6 variants were 59.8% and 64.6% in the EH group and 70.3% and 65.9% in the controls, respectively. The genotype and allele distribution of ADRB1 were significantly different between the 2 groups (P<0.05), but there was no significant difference in CYP2D6 distribution (P=0.91, 0.88). By logistic regression analysis, high fasting plasma glucose, smoking, high triglyceride, and the Gly/Gly polymorphism in Arg389Gly ADRB1 all emerged as independent risk factors for hypertension. Additionally, the ADRB1 genotype played a major role in the antihypertensive effect of metoprolol, and the patients with the Gly389Gly genotype showed a significantly better response to metoprolol than did those with a heterozygous ADRB1 mutation (Arg389Gly) (P=0.027). Conclusions The results demonstrate that Gly/Gly polymorphism in Arg389Gly ADRB1 was an independent risk factor together with high fasting plasma glucose, smoking, and high triglyceride; moreover, the patients who carried the Gly389Gly genotype had a significantly improved metoprolol antihypertensive effect than those with ADRB1.

      PubDate: 2017-11-20T02:52:07Z
      DOI: 10.1016/j.amjms.2017.11.002
       
  • Expression of miR-206 in Human Knee Articular Chondrocytes and Effects of
           miR-206 on Proliferation and Apoptosis of Articular Chondrocytes
    • Authors: Zhe Ni; Xifu Shang; Guolin Tang; Lei Niu
      Abstract: Publication date: Available online 13 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Zhe Ni, Xifu Shang, Guolin Tang, Lei Niu
      Objective Increasing evidence has demonstrated that microRNAsregulate the development of cartilage and osteogenesis. Whether miR-206 participates in the development of human articularcartilageremains largely unknown. This study aimed to investigate the role ofmiR-206inhumanchondrocytes. Methods Expression of miR-206 was initially assessed in humanosteoarthritis (OA)tissues and articularchondrocytes throughquantitative real-time polymerase chain reaction (qRT-PCR). Theeffects of miR-206 on proliferation, apoptosis of humanchondrocytes were assessedby 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide(MTT)and Annexin-Vfluorescein isothiocyanate(FITC)/propidium iodide (PI)double staining assay.Then, the effects of miR-206 on type II collagen alpha 1 (Col2a1), aggrecan, runt-related transcription factor 2 (RUNX2) and matrix metalloproteinase13 (MMP13) were examined with qRT-PCR and Western blot analysis. Results MiR-206 was significantly increased in human OA tissues and chondrocytes.MiR-206 significantly inhibitedthe proliferationof chondrocytes, but promotedapoptosis.Expression of Col2a1 and aggrecan were dramatically decreased, and the expression of RUNX2 and MMP13 were significantly increased when miR-206 was overexpressed. Conclusion MiR-206 may participate in cartilagedegradation in OA. Manipulation of the expression of miR-206 in human chondrocytes may be a novel therapeutic strategy for the treatment of OA.

      PubDate: 2017-11-20T02:52:07Z
      DOI: 10.1016/j.amjms.2017.11.003
       
  • The Effect of Race in Patients with Achalasia diagnosed by High Resolution
           Esophageal Manometry
    • Authors: Victor Chedid; Elizabeth Rosenblatt; Kunjal (Komal) Gandhi; Sameer Dhalla; Monica C. Nandwani; Ellen M. Stein; John O. Clarke
      Abstract: Publication date: Available online 13 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Victor Chedid, Elizabeth Rosenblatt, Kunjal (Komal) Gandhi, Sameer Dhalla, Monica C. Nandwani, Ellen M. Stein, John O. Clarke
      Background The advent of the Chicago Classification for esophageal motility disorders allowed for clinically reproducible subgrouping of patients with achalasia based on manometric phenotype. However, there is limited data with regards to racial variation using high-resolution esophageal manometry (HREM). The aim of our study was to evaluate the racial differences in patients with achalasia diagnosed with HREM using the Chicago Classification. We evaluated the clinical presentation, treatment decisions and outcomes between blacks and non-blacks with Achalasia to identify potential racial disparities. Methods We performed a retrospective review of consecutive patients referred for HREM at a single tertiary referral center from June 2008 through October 2012. All patients diagnosed with achalasia on HREM according to the Chicago Classification were included. Demographic, clinical, and manometric data were abstracted. All studies interpreted before the Chicago Classification was in widespread use were re-analyzed. Race was defined as black or non-black. Patients who had missing data were excluded. Proportions were compared using Chi-squared analysis and means were compared using the Student′s t-test. Results A total of 1,268 patients underwent HREM during the study period and 105 (8.3%) were manometrically diagnosed with achalasia (53% female, mean age: 53.8 +/- 17.0 years) and also met the aforementioned inclusion/exclusion criteria. A higher percentage of women presented with achalasia in blacks as compared to whites or other races (p<0.001). Non-blacks were more likely to present with reflux than blacks (p=0.01), while blacks were more likely to be treated on the inpatient service than non-blacks (p<0.001). There were no other significant differences noted in clinical presentation, treatment decisions and treatment outcomes among blacks and non-blacks. Conclusions Our study highlights possible racial differences between blacks and non-blacks, including a higher proportion of black women diagnosed with achalasia and most blacks presenting with dysphagia. There is possibly a meaningful interaction of race and gender in the development of achalasia that might represent genetic differences in its pathophysiology. Further prospective studies are required to identify such differences.

      PubDate: 2017-11-20T02:52:07Z
      DOI: 10.1016/j.amjms.2017.11.004
       
  • Effectiveness of Bulking Agent (Solesta) Therapy in Fecal Incontinence in
           Patients Refractory to Conventional Therapies
    • Authors: Ihsan Al-Bayati; Mohammed Saadi; Sherif Elhanafi; Richard W. McCallum
      Abstract: Publication date: Available online 5 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Ihsan Al-Bayati, Mohammed Saadi, Sherif Elhanafi, Richard W. McCallum
      Background Fecal incontinence is a problem that imposes considerable socioeconomic consequences. Despite many medical therapies, unmet needs remain. A new treatment option is a biocompatible bulking agent (Solesta) administered by submucosal injection in the distal rectum. The aims of this study are as follows: (1) To evaluate the efficacy and safety of this bulking agent in decreasing the severity of fecal incontinence (FI) and improving quality of life. (2) To obtain objective evidence of changes in anorectal physiology by high-resolution anorectal manometry pretreatment and posttreatment. Materials and Methods From January 2014 to June 2015, 17 patients who had failed medical therapy for FI received stabilized hyaluronate injected submucosally into the rectum under direct anoscopic visualization. The treatment was considered successful if patients achieved >50% reduction in FI events during monitoring for up to 12 months. Results After the first treatment session, 14 patients (82.3%) had a successful outcome. The remaining 3 patients received a second therapy 3 months later to achieve this result. At last follow-up, 7 of the 17 patients (41%) were having no FI events. The remaining patients had reduction in fecal accidents from a mean of 6.4/week baseline to 2.8/week during follow-up. Conclusions Intrarectal injection of stabilized hyaluronate is effective for treating FI in patients who had failed standard medical treatments and is technically easy and safely performed as an outpatient procedure.

      PubDate: 2017-11-20T02:52:07Z
      DOI: 10.1016/j.amjms.2017.09.001
       
  • Differential Expression and Significance of Endoplasmic Reticulum Golgi
           Intermediate Compartment 1 in Precancerous Gastric Lesions and Gastric
           Cancer
    • Authors: Furong Wang; Xiaoying Guan; Jinwei Yang; Wenting He; Yucai Wei; Hao Chen; Yumin Li
      Abstract: Publication date: Available online 9 November 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Furong Wang, Xiaoying Guan, Jinwei Yang, Wenting He, Yucai Wei, Hao Chen, Yumin Li
      Background We investigated the expression of endoplasmic reticulum Golgi intermediate compartment 1 (ERGIC1) in precancerous gastric lesions and gastric cancer and function of ERGIC in human gastric cancer cell lines. Materials and Methods A total of 160 subjects were enrolled. The expression of ERGIC1 was assayed using immunohistochemistry. ERGIC1 over-expressed SGC-7901 and BGC-823 cells were used to evaluate the function of ERGIC1. Results Most normal gastric mucosal tissues and the tissues with mild dysplasia showed strong (+++) expression of ERGC1 (80% and 73.3%, respectively) assayed using immunohistochemistry. In the majority of gastric tissues with moderate- and severe dysplasia, ERGC1 was moderately (++) positive (83.3% and 66.7%, respectively), whereas in a small proportion of gastric tissues with severe dysplasia (16.7%) and of the gastric cancer tissues (22.5%), ERGC1 was weakly positive (+). No expression of ERGC1 was found in the gastric tissues of a small proportion of severe dysplasia (16.7%) and in the most of the gastric cancer (67.5%) patients. Semi-quantitative analysis revealed a gradual reduction in the expression score of ERGIC1 from normal gastric mucosal tissues to tissues from early gastric cancer. In addition, over-expression of ERGIC1 in SGC-7901 and BGC-823 cells inhibited the cell proliferation by 27.5% and 30%, respectively, on day 5. On the other hand, over-expression of ERGIC1 in both cell lines enhanced the apoptosis by 33.5% and 53.2%, respectively, as compared to control cells. Conclusion These results suggested that ERGIC1 might play an inhibitory role in the initiation and progression of gastric cancer.

      PubDate: 2017-11-11T09:20:35Z
      DOI: 10.1016/j.amjms.2017.11.001
       
  • Health Care is a Human Right – Pro
    • Authors: Ann Schraufnagel; William Schraufnagel Dean Schraufnagel
      Abstract: Publication date: Available online 6 October 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Ann M. Schraufnagel, William E. Schraufnagel, Dean E. Schraufnagel


      PubDate: 2017-10-08T13:46:46Z
       
  • Editorial: Aortic Aneurysm in Takayasu Arteritis11The authors have no
           conflict of interest related to this editorial.
    • Authors: Jose Leon; Rocha Luis Espinoza
      Abstract: Publication date: Available online 4 October 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Jose A. Leon de la Rocha, Luis R. Espinoza


      PubDate: 2017-10-08T13:46:46Z
       
  • Is healthcare a human right' No
    • Authors: Gilbert Berdine
      Abstract: Publication date: Available online 4 October 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Gilbert G. Berdine


      PubDate: 2017-10-08T13:46:46Z
       
  • Editorial: The distribution of plasma electrolytes
    • Authors: Shruti Gupta; Andrew Z. Fenves
      Abstract: Publication date: Available online 5 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Shruti Gupta, Andrew Z. Fenves


      PubDate: 2017-09-06T01:10:35Z
      DOI: 10.1016/j.amjms.2017.08.025
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 54.226.132.197
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2016