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Publisher: Elsevier   (Total: 3123 journals)

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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, 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: 381, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, 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   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 239, 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: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, 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: 5)
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: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 141, 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: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, 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: 26, 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: 6, 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: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, 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: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, 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: 17, 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: 27)
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: 10)
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: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, 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: 2)
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: 16, 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: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, 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: 371, 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: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, 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: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, 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: 339, 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: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 435, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, 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: 9, 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: 49, 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: 48, 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: 42, 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: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, 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: 207, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, 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: 24, 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: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, 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: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
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: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 172, 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: 178, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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Journal Cover American Journal of the Medical Sciences
  [SJR: 0.653]   [H-I: 70]   [12 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9629
   Published by Elsevier Homepage  [3123 journals]
  • Trichuriasis
    • Authors: Raghav Bansal; Tiangui Huang; Soohwan Chun
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Raghav Bansal, Tiangui Huang, Soohwan Chun


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.09.003
       
  • Aortic Intramural Hemorrhage Secondary to Penetrating Atherosclerotic
           Ulcers
    • Authors: Rahul Hegde; Shuo Li; Nishant Gupta; Steven Cohen
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Rahul Hegde, Shuo Li, Nishant Gupta, Steven Cohen


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.10.004
       
  • Genetic Predisposition and Effect of Race in Achalasia
    • Authors: Lokesh K. Jha; Alexander T. Hewlett
      First page: 101
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Lokesh K. Jha, Alexander T. Hewlett


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.12.006
       
  • Infection-Related Mortality in Patients With Cirrhosis
    • Authors: Don C. Rockey
      Pages: 102 - 103
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Don C. Rockey


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.12.020
       
  • Research Ethics in Behavioral Interventions Among Special Populations:
           Lessons From the Peer Approaches to Lupus Self-Management Study
    • Authors: Trevor D. Faith; Leonard Egede; Edith M. Williams
      Pages: 104 - 112
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Trevor D. Faith, Leonard Egede, Edith M. Williams
      Background Research involving a homogenous cohort of participants belonging to a special population must make considerations to recruit and protect the subjects. This study analyses the ethical considerations made in the peer approaches to lupus self-management project which pilot tested a peer mentoring intervention for African American women with systemic lupus erythematosus. Methods Considerations made at the outset of the project are described and their justifications and reasoning are given. Through analysis of feedback from a postintervention focus group and mentors' logs, implications on program outcomes and participant satisfaction are discussed. Results Feedback indicated the importance of recruiting and training capable mentors, consistent contact from study staff to avert adverse events and avert fear or mistrust and careful consideration that must go into the pairing of mentors and mentees. Participant feedback also indicated that sensitive topics must be addressed carefully to prevent distress and dissatisfaction. Conclusions Applying the lessons learned from this work as well as the considerations that proved successful may improve the contextualization and ethical conduct of behavioral interventions in special populations resulting in improved tailoring and acceptability toward historically underserved individuals.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.08.021
       
  • Cardiac Sarcoidosis: A Review of Contemporary Challenges in Diagnosis and
           Treatment
    • Authors: Yan Yatsynovich; Nathaniel Dittoe; Mikhail Petrov; Natallia Maroz
      Pages: 113 - 125
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Yan Yatsynovich, Nathaniel Dittoe, Mikhail Petrov, Natallia Maroz
      Sarcoidosis is a systemic disease characterized by noncaseating granulomas and is often a diagnosis of exclusion. The actual prevalence of cardiac sarcoidosis (CS) is unknown, as studies have demonstrated mixed data. CS may be asymptomatic and is likely more frequently encountered than previously thought. Sudden death may often be the presenting feature of CS. Most deaths attributed to CS are caused by arrhythmias or conduction system disease, and congestive heart failure may occur. Current expert consensus on diagnosis of CS continues to rely on endomyocardial biopsy, in the absence of which, histologic proof of extracardiac sarcoid involvement is necessitated. Emergence of newer noninvasive imaging modalities such as cardiac magnetic resonance imaging and positron emission tomography, have become increasingly popular tools utilized in patients with both clinical and asymptomatic CS, and have demonstrated good diagnostic capability. The main therapeutic approaches in patients with CS can be broadly divided into the following 2 categories: pharmacological management and invasive or device oriented. However, much remains unknown about the optimal screening protocols of asymptomatic patients with extracardiac sarcoidosis and treatment of biopsy-proven CS. Our knowledge about CS has amplified significantly over the last 30 years and the growing realization that this process is often asymptomatic is paving the way for better screening protocols and earlier detection of this serious condition.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.08.009
       
  • The Effect of Race in Patients with Achalasia Diagnosed With
           High-Resolution Esophageal Manometry
    • Authors: Victor Chedid; Elizabeth Rosenblatt; Kunjal (Komal) Gandhi; Sameer Dhalla; Monica C. Nandwani; Ellen M. Stein; John O. Clarke
      Pages: 126 - 131
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      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 are 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. Materials and 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 reanalyzed. 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 and 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 sex in the development of achalasia that might represent genetic differences in its pathophysiology. Further prospective studies are required to identify such differences.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.11.004
       
  • Community- or Healthcare-Associated Bacterial Infections Increase
           Long-Term Mortality in Patients With Acute Decompensation of Cirrhosis
    • Authors: Hong Zhao; Yu Shi; Huihui Dong; Jianhua Hu; Xuan Zhang; Meifang Yang; Jun Fan; Weihang Ma; Jifang Sheng; Lanjuan Li
      Pages: 132 - 139
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Hong Zhao, Yu Shi, Huihui Dong, Jianhua Hu, Xuan Zhang, Meifang Yang, Jun Fan, Weihang Ma, Jifang Sheng, Lanjuan Li
      Background The aim of the present study was to determine the specific role of different types of bacterial infections (BIs) on the prognosis of cirrhotic patients with acute decompensation (AD). Methods We performed a prospective, observational cohort study consisting of 492 cirrhotic patients with AD at our center from February 2014 to March 2015. Clinical, laboratory and survival data were collected. The relationship between BIs and mortality was analyzed. Results BIs were identified in 157 of 492 patients at the time of admission or during the hospital stay. Among the patients, 65 had community-acquired (CA) or healthcare-associated (HCA) BIs, 54 developed hospital-acquired (HA) BIs, and 38 had CA/HCA with HA BIs. Patients with CA/HCA BIs had higher 90-day, 1-year and 2-year mortality rates (29.2%, 44.6% and 52.3%, respectively) and CA/HCA BIs remained an independent risk factor for long-term mortality on multivariate analysis (1 year: hazard ratio = 1.60; 95% CI: 1.07-2.41; P = 0.023 and 2 year: hazard ratio = 1.54; 95% CI: 1.05-2.25; P = 0.026). In contrast, patients with HA BIs had a higher 28-day mortality rate than patients with CA/HCA BIs. Logistic regression analysis showed previous ascites and prior BIs within 3 months were independent risk factors for CA/HCA BIs, whereas invasive minor surgical procedures with acute-on-chronic liver failure throughout the hospital stay and high chronic liver failure-sequential organ failure assessment scores were associated with nosocomial BIs. Conclusions CA/HCA BIs were associated with increased long-term mortality in cirrhotic patients with AD, whereas nosocomial BIs may be related to poor short-term prognosis.

      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2017.08.003
       
  • Geographic and Individual Correlates of Subclinical Atherosclerosis in an
           Asymptomatic Rural Appalachian Population
    • Authors: Hadii M. Mamudu; Antwan Jones; Timir Paul; Pooja Subedi; Liang Wang; Arsham Alamian; Ali E. Alamin; Gerald Blackwell; Matthew Budoff
      Pages: 140 - 148
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Hadii M. Mamudu, Antwan Jones, Timir Paul, Pooja Subedi, Liang Wang, Arsham Alamian, Ali E. Alamin, Gerald Blackwell, Matthew Budoff
      Background This study aimed to examine the association between subclinical atherosclerosis (ascertained as coronary artery calcium [CAC]) in asymptomatic individuals in the Central Appalachian region of the United States and individual- and geographic-level factors. Materials and Methods Data were obtained from participants in CAC screening between 2012 and 2016. CAC score was assessed as CAC = 0 (no plaque), 1 ≤ CAC ≤ 99 (mild plaque), 100 ≤ CAC ≤ 399 (moderate plaque) and CAC ≥ 400 (severe plaque). Additionally, data on demographics (age, sex and race), medical conditions, lifestyle factors and family history of coronary artery disease were obtained. Further, zip codes of place of residence for participants were used to generate geographic-level data. Descriptive statistics were used to estimate the prevalence of CAC, and multinomial logistic regression models were used to delineate significant factors. Results Of 1,512 participants, 57.6% had CAC > 0. The prevalence of mild, moderate and severe plaques was 31.6%, 16.3% and 9.7%, respectively. Demographics (age and sex), medical conditions, lifestyle factors and family history of coronary artery disease were associated with increased risk for subclinical atherosclerosis. Further, the proportion of minority residents significantly increased the risk for severe plaque (relative risk ratio = 1.06, P = 0.04) and the proportion of residents on government assistance significantly decreased the risk for mild plaque (relative risk ratio = 0.93, P = 0.03). Conclusions The results imply that the proportion of minority residents in a geographic area is associated with increased relative risk for subclinical atherosclerosis, while the proportion of residents on government assistance decreased such risk. However, future geographic or neighborhood-level studies with a larger sample size are needed to delineate further the consistency of these results in the Central Appalachian population.

      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2017.08.011
       
  • First Trimester Neck Circumference as a Predictor for the Development of
           Gestational Diabetes Mellitus
    • Authors: Ping Li; Shuo Lin; Jinhui Cui; Ling Li; Shuisheng Zhou; Jianhui Fan
      Pages: 149 - 152
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Ping Li, Shuo Lin, Jinhui Cui, Ling Li, Shuisheng Zhou, Jianhui Fan
      Backgrounds This study aimed to evaluate the relationship between neck circumference (NC) and gestational diabetes mellitus (GDM), and the efficacy of NC in predicting GDM by comparing with pregestational body mass index (preBMI) in southern Chinese woman. Marerials and Methods A total of 371 pregnant women (97 GDM and 274 normal pregnant women) were recruited from the third affiliated hospital of Sun Yat-Sen University, Guangzhou, China. NC was measured at 11-13+6 gestational weeks. GDM was diagnosed through a 75-g oral glucose tolerance test at 24-28 gestational weeks. Using the receiver-operator characteristic (ROC) curve analysis, we evaluated the association between NC and GDM. Results The area under the receiver operator characteristic curves were 0.65 (95% CI: 0.60-0.70) for NC and 0.64 (95% CI: 0.59-0.69) for preBMI in diagnosing GDM and no difference was found between them (P = 0.66). NC ≥ 33.8cm was determined to be the best cut-off level for identifying subjects with GDM (sensitivity 68.04% and specificity 59.12%). Multivariate logistic regression analysis showed that a large NC in the first trimester was an independent risk factor for the development of GDM (odds ratio [OR] = 1.29, 95% CI: 1.72-7.45). Conclusions NC, as well as preBMI, might be a novel anthropometric index for GDM screening. The increase of NC could be an independent risk factor for GDM in first trimester pregnancy.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.09.012
       
  • Fibromyalgia and Risk of Dementia—A Nationwide, Population-Based,
           Cohort Study
    • Authors: Nian-Sheng Tzeng; Chi-Hsiang Chung; Feng-Cheng Liu; Yu-Hsiang Chiu; Hsin-An Chang; Chin-Bin Yeh; San-Yuan Huang; Ru-Band Lu; Hui-Wen Yeh; Yu-Chen Kao; Wei-Shan Chiang; Chang-Hui Tsao; Yung-Fu Wu; Yu-Ching Chou; Fu-Huang Lin; Wu-Chien Chien
      Pages: 153 - 161
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Nian-Sheng Tzeng, Chi-Hsiang Chung, Feng-Cheng Liu, Yu-Hsiang Chiu, Hsin-An Chang, Chin-Bin Yeh, San-Yuan Huang, Ru-Band Lu, Hui-Wen Yeh, Yu-Chen Kao, Wei-Shan Chiang, Chang-Hui Tsao, Yung-Fu Wu, Yu-Ching Chou, Fu-Huang Lin, Wu-Chien Chien
      Background Fibromyalgia is a syndrome of chronic pain and other symptoms and is associated with patient discomfort and other diseases. This nationwide matched-cohort population-based study aimed to investigate the association between fibromyalgia and the risk of developing dementia, and to clarify the association between fibromyalgia and dementia. Materials and Methods A total of 41,612 patients of age ≥50 years with newly diagnosed fibromyalgia between January 1, and December 31, 2000 were selected from the National Health Insurance Research Database of Taiwan, along with 124,836 controls matched for sex and age. After adjusting for any confounding factors, Fine and Gray competing risk analysis was used to compare the risk of developing dementia during the 10 years of follow-up. Results Of the study subjects, 1,704 from 41,612 fibromyalgia patients (21.23 per 1,000 person-years) developed dementia when compared to 4,419 from 124,836 controls (18.94 per 1,000 person-years). Fine and Gray competing risk analysis revealed that the study subjects were more likely to develop dementia (hazard ratio: 2.29, 95% CI: 2.16-2.42; P < 0.001). After adjusting for sex, age, monthly income, urbanization level, geographic region of residence and comorbidities the hazard ratio was 2.77 (95% CI: 2.61-2.95, P < 0.001). Fibromyalgia was associated with increased risk of all types of dementia in this study. Conclusions The study subjects with fibromyalgia had a 2.77-fold risk of dementia in comparison to the control group. Therefore, further studies are needed to elucidate the underlying mechanisms of the association between fibromyalgia and the risk of dementia.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.09.002
       
  • Reciprocal ST-Segment Changes in Myocardial Infarction: Ischemia at
           Distance Versus Mirror Reflection of ST-Elevation
    • Authors: Gaurang Nandkishor Vaidya; Steve Antoine; Syed Haider Imam; Hani Kozman; Harold Smulyan; Daniel Villarreal
      Pages: 162 - 167
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Gaurang Nandkishor Vaidya, Steve Antoine, Syed Haider Imam, Hani Kozman, Harold Smulyan, Daniel Villarreal
      Background Reciprocal ST-depression in the electrocardiograms (ECGs) of patients with ST-elevation myocardial infarction (STEMI) results from either true ischemia at a distance via collateral circulation diverting blood to the infarcted region or an electrical phenomenon that results from a mirror reflection of ST-elevation. We aimed to identify the role of reciprocal ECG changes in predicting collateral circulation to the infarcted area determined angiographically. Methods In a retrospective study, ECG and angiography of 53 STEMI patients admitted to SUNY Upstate Medical University in 2014 were reviewed independently by experts blinded to the results of ECG and coronary angiography. Results Reciprocal changes (RC) in ECG were present in 41 patients (77%) and on angiography, 14 patients (26%) exhibited collateral vessels to the ischemic areas. No correlation was found between the presence of RC and collateral circulation (P = 0.384), or between the depth of reciprocal ST-depression and the degree of the collateral circulation (P = 0.195). However, 84% of patients without collaterals exhibited resolution of RC after successful percutaneous coronary intervention (PCI) (P = 0.036), suggesting that the ST depressions that resolved after reperfusion were directly caused by the culprit vessel. Patients without RC presented late after symptom onset (9.25 versus 3.83 hours, P = 0.004), also suggesting time related resolution. Conclusions RC had no relation to or predictive value for collaterals on angiography. Among late presenting patients, RC were less frequent. Thus, reciprocal ST-depression may represent subendocardial ischemia from the primary coronary event or simply an electrical phenomenon, rather than ischemia at distance from impaired collateral circulation.

      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2017.09.004
       
  • Comparing Changes in Carotid Flow Time and Stroke Volume Induced by
           Passive Leg Raising
    • Authors: Bilal Jalil; Patton Thompson; Rodrigo Cavallazzi; Paul Marik; Jason Mann; Karim El-Kersh; Juan Guardiola; Mohamed Saad
      Pages: 168 - 173
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Bilal Jalil, Patton Thompson, Rodrigo Cavallazzi, Paul Marik, Jason Mann, Karim El-Kersh, Juan Guardiola, Mohamed Saad
      Background Determining volume responsiveness in critically ill patients is challenging. We sought to determine if passive leg raise (PLR) induced changes in pulsed wave Doppler of the carotid artery flow time could predict fluid responsiveness in critically ill patients. Materials and Methods Medical intensive care unit patients ≥18 years old with a radial arterial line and FloTrac/Vigileo monitor in place were enrolled. Pulsed wave Doppler of the carotid artery was performed to measure the change in carotid flow time (CFTC) in response to a PLR. Patients were categorized as fluid responders if stroke volume increased by ≥15% on a Vigileo monitor. The main outcome measure was the accuracy of CFTC to detect a change in response to a PLR. We also calculated the percentage increase in CFTC that could predict fluid responsiveness. Results We enrolled 22 patients. Using an increase of ≥24.6% in the CFTC in response to PLR to predict fluid responsiveness there was a sensitivity of 60%, specificity of 92%, positive likelihood ratio of 7.2, negative likelihood ratio of 0.4, positive predictive value of 86%, negative predictive value of 73% and receiver operating characteristic of 0.75 (95% CI: 0.54-0.96). Conclusions CFTC performs well compared to stroke volume measurements on a Vigileo monitor. The use of CFTC is highlighted in resource-limited environments and when time limits the use of other methods. CFTc should be validated in a larger study with more operators against a variety of hemodynamic monitors.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.09.006
       
  • Effect of Chronic Total Occlusion Percutaneous Coronary Intervention on
           Clinical Outcomes in Elderly Patients
    • Authors: Hui-Ping Zhang; Hu Ai; Ying Zhao; Hui Li; Guo-Dong Tang; Nai-Xin Zheng; Fu-Cheng Sun; Jing-Hua Liu
      Pages: 174 - 182
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Hui-Ping Zhang, Hu Ai, Ying Zhao, Hui Li, Guo-Dong Tang, Nai-Xin Zheng, Fu-Cheng Sun, Jing-Hua Liu
      Background There are little published data reporting the effect of coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on the prognosis of elderly patients with identified CTOs. We sought to evaluate the clinical effect of CTO PCI on the prognosis of elderly patients with CTOs. Methods A total of 445 consecutive patients diagnosed with a CTO by angiography from January 2011 to December 2013 were enrolled. We compared long-term clinical outcomes between the elderly group (≥75 years; n = 120, 27.0%), and the nonelderly group (<75 years; n = 325, 73.0%) as well as between patients with unopened CTOs and patients with CTOs who were recanalized by PCI either during the index hospitalization or at a staged procedure within 30 days after discharge from the index hospitalization. The primary endpoint was defined as the composite of hospitalization from angina, reinfarction, heart failure or repeat revascularization and cardiac death at the 3-year follow-up. Results More elderly CTO patients had left main (LM) disease (25.0 versus 15.1%, P = 0.015), 3-vessel disease (96.4% versus 73.8%, P < 0.001) and a Japan-CTO score ≥2 (36.7% versus 23.7%, P = 0.006) than nonelderly CTO patients. Furthermore, elderly patients had a higher syntax score than nonelderly patients (27.0 [25.0, 30.0] versus 26.0 [23.0, 30.0], P = 0.006). PCI was attempted for 33 out of 135 CTO lesions (24.4%) in the elderly group, and 127 out of 378 lesions (33.6%) in the nonelderly group (P = 0.049); however, there were no statistically significant differences in the CTO PCI success rates between the 2 groups (69.7% versus 82.7%, P = 0.097). The 3-year cardiac mortality rate was 15.0% and 4.6% (P < 0.011) for the elderly and nonelderly groups, respectively. Elderly patients with CTOs who were recanalized by PCI and those with unopened CTOs exhibited comparable 3-year cardiac mortality rates (15.0% versus 16.0%, P = 1.000). There was no significant difference in primary endpoint incidence (25.0% versus 33.0%, P = 0.486). Multivariate analysis revealed that after corrections for baseline and procedural differences, right coronary artery CTO (odds ratio = 4.600, 95% CI: 1.320-16.031; P = 0.017) and LM disease combined with 3-vessel disease (odds ratio = 4.296, 95% CI: 1.166-15.831; P = 0.028) were independent predictors of 3-year cardiac mortality among elderly patients with CTOs. Conclusions Elderly patients with CTOs presented with seriously diseased coronary arteries and poor prognoses. CTO PCI did not seem to significantly improve long-term clinical outcomes among elderly patients with CTOs. Right coronary artery CTO and LM disease combined with 3-vessel disease might be independent predictors of 3-year cardiac mortality in elderly CTO patients.

      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2017.09.007
       
  • Iron Enhances Hepatic Fibrogenesis and Activates Transforming Growth
           Factor-β Signaling in Murine Hepatic Stellate Cells
    • Authors: Kosha J. Mehta; Jason D. Coombes; Marco Briones-Orta; Paul P. Manka; Roger Williams; Vinood B. Patel; Wing-Kin Syn
      Pages: 183 - 190
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Kosha J. Mehta, Jason D. Coombes, Marco Briones-Orta, Paul P. Manka, Roger Williams, Vinood B. Patel, Wing-Kin Syn
      Background Although excess iron induces oxidative stress in the liver, it is unclear whether it directly activates the hepatic stellate cells (HSC). Materials and Methods We evaluated the effects of excess iron on fibrogenesis and transforming growth factor beta (TGF-β) signaling in murine HSC. Cells were treated with holotransferrin (0.005-5g/L) for 24 hours, with or without the iron chelator deferoxamine (10µM). Gene expressions (α-SMA, Col1-α1, Serpine-1, TGF-β, Hif1-α, Tfrc and Slc40a1) were analyzed by quantitative real time-polymerase chain reaction, whereas TfR1, ferroportin, ferritin, vimentin, collagen, TGF-β RII and phospho-Smad2 proteins were evaluated by immunofluorescence, Western blot and enzyme-linked immunosorbent assay. Results HSC expressed the iron-uptake protein transferrin receptor 1 (TfR1) and the iron-export protein ferroportin. Holotransferrin upregulated TfR1 expression by 1.8-fold (P < 0.03) and ferritin accumulation (iron storage) by 2-fold (P < 0.01), and activated HSC with 2-fold elevations (P < 0.03) in α-SMA messenger RNA and collagen secretion, and a 1.6-fold increase (P < 0.01) in vimentin protein. Moreover, holotransferrin activated the TGF-β pathway with TGF-β messenger RNA elevated 1.6-fold (P = 0.05), and protein levels of TGF-β RII and phospho-Smad2 increased by 1.8-fold (P < 0.01) and 1.6-fold (P < 0.01), respectively. In contrast, iron chelation decreased ferritin levels by 30% (P < 0.03), inhibited collagen secretion by 60% (P < 0.01), repressed fibrogenic genes α-SMA (0.2-fold; P < 0.05) and TGF-β (0.4-fold; P < 0.01) and reduced levels of TGF-β RII and phospho-Smad2 proteins. Conclusions HSC express iron-transport proteins. Holotransferrin (iron) activates HSC fibrogenesis and the TGF-β pathway, whereas iron depletion by chelation reverses this, suggesting that this could be a useful adjunct therapy for patients with fibrosis. Further studies in primary human HSC and animal models are necessary to confirm this.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.08.012
       
  • Paraganglioma of the Urinary Bladder: A Rare Cause of Hypertension and
           Urinary Tract Infections
    • Authors: Gerard Chaaya; Jorge Morales; Analia Castiglioni; Noman Subhani; Abdo Asmar
      Pages: 191 - 194
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Gerard Chaaya, Jorge Morales, Analia Castiglioni, Noman Subhani, Abdo Asmar
      Pheochromocytoma is a neoplasm, which develops from cells of the chromaffin tissues that are derived from the ectodermic neural system and mostly situated within the adrenal medulla. Approximately 15% of pheochromocytoma cases arise from extra-adrenal chromaffin tissue. Pheochromocytoma of the bladder is rare and accounts for less than 0.06% of all bladder neoplasms and less than 1% of all pheochromocytomas. We report a case of a young woman who presented with uncontrolled hypertension, recurrent urinary tract infections and micturition attacks and was found to have a metastatic bladder paraganglioma. In addition, we provide a summary table of the clinical manifestations of paragangliomas based on anatomic locations.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.03.037
       
  • Hypocomplementemic Urticarial Vasculitis Syndrome With Crescentic
           Glomerulonephritis
    • Authors: Sohail Abdul Salim; Tauqeer Yousuf; Asha Patel; Tibor Fülöp; Mohit Agarwal
      Pages: 195 - 200
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Sohail Abdul Salim, Tauqeer Yousuf, Asha Patel, Tibor Fülöp, Mohit Agarwal
      Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare autoimmune disease characterized by multiple organ system involvement, including renal disease, with low complement levels. We report the case of a 31-year-old woman who presented with nonspecific symptoms including fatigue, diarrhea, macular rash and abdominal pain with acute renal failure leading to end-stage kidney disease. Laboratory results showed hematuria, nephrotic range proteinuria, worsening creatinine and low C1q levels. Left kidney biopsy showed proliferative glomerulonephritis with crescent formation. She was treated with 6 months of intravenous cyclophosphamide, followed by 2 doses of intravenous rituximab (1g each), thereafter maintained on mycophenolate mofetil and glucocorticoid-based therapy. She experienced a full recovery of renal function after 12 months of dialysis dependence. Hypocomplementemic urticarial vasculitis syndrome with crescentic glomerulonephritis is a rare disease with only 5 other reported cases in literature. In our case, we document a delayed but excellent renal recovery during a 2-year follow-up.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.04.004
       
  • Lymphocyte-Variant Hypereosinophilic Syndrome With Eosinophilic
           Myocarditis Treated With Steroids and Pegylated Interferon Alfa-2a
    • Authors: Christopher C. Cheung; Maggie Constantine; Amir Ahmadi; Carolyn Shiau; Luke Y.C. Chen
      Pages: 201 - 202
      Abstract: Publication date: February 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 2
      Author(s): Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau, Luke Y.C. Chen


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.03.030
       
  • Pulmonary Hypertension—Is It the Same Disease in Young Versus Older
           Patients'
    • Authors: Karen A. Fagan
      Pages: 1 - 2
      Abstract: Publication date: January 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 1
      Author(s): Karen A. Fagan


      PubDate: 2018-01-04T14:49:08Z
      DOI: 10.1016/j.amjms.2017.11.018
       
  • Cannabinoids and Symptomatic Bradycardia
    • Authors: Mark R. Heckle; Mannu Nayyar; Scott E. Sinclair; Karl T. Weber
      Pages: 3 - 5
      Abstract: Publication date: January 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 1
      Author(s): Mark R. Heckle, Mannu Nayyar, Scott E. Sinclair, Karl T. Weber
      Cannabinoids, the bioactive components of marijuana, have adverse cardiovascular consequences, including symptomatic sinus bradycardia, sinus arrest and ventricular asystole. Physicians should be aware of these deleterious consequences which can appear in otherwise healthy persons who are chronic marijuana users.

      PubDate: 2018-01-04T14:49:08Z
      DOI: 10.1016/j.amjms.2017.03.027
       
  • Topical Treatment of Degenerative Knee Osteoarthritis
    • Authors: Zengdong Meng; Rongzhong Huang
      Pages: 6 - 12
      Abstract: Publication date: January 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 1
      Author(s): Zengdong Meng, Rongzhong Huang
      This article reviews topical management strategies for degenerative osteoarthritis (OA) of the knee. A search of Pubmed, Embase and the Cochrane library using MeSH terms including “topical,” “treatment,” “knee” and “osteoarthritis” was carried out. Original research and review articles on the effectiveness and safety, recommendations from international published guidelines and acceptability studies of topical preparations were included. Current topical treatments included for the management of knee OA include topical nonsteroidal anti-inflammatory drugs, capsaicin, salicylates and physical treatments such as hot or cold therapy. Current treatment guidelines recommend topical nonsteroidal anti-inflammatory drugs as an alternative and even first-line therapy for OA management, especially among elderly patients. Guidelines on other topical treatments vary, from recommendations against their use, to in favor as alternative or simultaneous therapy, especially for patients with contraindications to other analgesics. Although often well-tolerated and preferred by many patients, clinical care still lags in the adoption of topical treatments. Aspects of efficacy, safety and patient quality of life data require further research.

      PubDate: 2018-01-04T14:49:08Z
      DOI: 10.1016/j.amjms.2017.06.006
       
  • The Complexity of Characteristics, Diagnoses and Treatment of Older
           Patients With Pulmonary Hypertension
    • Authors: Hawa Edriss; Kavitha Selvan; Tatiana Denega; Terrance Rodrigues; Victor Test; Kenneth Nugent
      Pages: 13 - 20
      Abstract: Publication date: January 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 1
      Author(s): Hawa Edriss, Kavitha Selvan, Tatiana Denega, Terrance Rodrigues, Victor Test, Kenneth Nugent
      Background Older patients with pulmonary hypertension (PH) are more likely to have complex comorbidity than younger patients with pulmonary arterial hypertension (PAH). The best approach to the evaluation and management of these patients is unclear. Methods We, retrospectively, reviewed the clinical records of patients older than 60 years referred for evaluation for PAH. We recorded patient demographics, comorbidity, functional classification (FC), right heart catheterization data, echocardiographic data, chest radiographic images and pulmonary function results. We recorded the final diagnoses according to World Health Organization (WHO) subgroups and treatment outcomes based on changes in FC. Results Ninety-seven records were reviewed in detail. The mean age was 71.2 ± 7.5 years with 66% women. Cardiovascular disease was the most frequent comorbidity. Mean PA pressure by catheterization was 39.5 ± 12.2mmHg (n = 65). The overall distribution after evaluation included 21 (21.6%) Group 1, 35 (36.1%) Group 2, 16 (16.5%) Group 3, 18 (18.6%) mixed Group 2 and 3, 6 (6.2%) Group 4 and 1 (1%) Group 5 patients. Group 1 patients were treated with PAH specific drug, and 12 patients had an improvement in FC with treatment. Conclusions Older patients with suspected PH often have significant cardiovascular and respiratory comorbidity. Comprehensive evaluations are needed to determine the severity of PH and associated diseases and to initiate treatment focused on FC. Patients in WHO Group 2 and mixed Group 2 and 3 were frequently identified and constituted a diagnostic and treatment challenge in this study. Older patients with PAH may benefit from PAH specific drugs.

      PubDate: 2018-01-04T14:49:08Z
      DOI: 10.1016/j.amjms.2017.07.008
       
  • Identification and Ablation of Dormant Conduction in Atrial Fibrillation
           Using Adenosine
    • Authors: Faraz Khan Luni; Abdur Rahman Khan; Hemindermeet Singh; Haris Riaz; Sonia Ali Malik; Owais Khawaja; Talha Farid; Jennifer Cummings; Mohammed Taleb
      Pages: 27 - 36
      Abstract: Publication date: January 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 1
      Author(s): Faraz Khan Luni, Abdur Rahman Khan, Hemindermeet Singh, Haris Riaz, Sonia Ali Malik, Owais Khawaja, Talha Farid, Jennifer Cummings, Mohammed Taleb
      Background Ablation is used for treatment of atrial fibrillation (AF) but recurrence is common. Dormant conduction is hypothesized to be responsible for these recurrences, and the role of adenosine in identification and ablation of these pathways is controversial with conflicting results on AF recurrence. Materials and Methods We conducted a meta-analysis for studies evaluating AF ablation and adenosine use. Included in the meta-analysis were human studies that compared ablation using adenosine or adenosine triphosphate (ATP) and reported freedom from AF in patients beyond a minimum follow-up of 6 months. Results Our analysis suggests that the use of adenosine leads to a decrease in recurrence of AF compared to the cohort which did not utilize adenosine. Subgroup analysis showed no difference in the recurrence of AF with the modality used for ablation (cryoablation vs. radiofrequency ablation) or with the preparation of adenosine used (ATP vs. adenosine). There was a significant benefit in delayed administration of ATP over early administration. Pooling results of only randomized control trials did not show any significant difference in AF recurrence. Conclusions Adenosine-guided identification and ablation of dormant pathways may lead to a decrease in recurrence of AF.

      PubDate: 2018-01-04T14:49:08Z
      DOI: 10.1016/j.amjms.2017.09.005
       
  • Relationship Between Serum Macrophage Migration Inhibitory Factor Level
           and Insulin Resistance, High-Sensitivity C-Reactive Protein and Visceral
           Fat Mass in Prediabetes
    • Authors: Oktay Bilgir; Belma Gökçen; Ferda Bilgir; Aslı Guler; Mehmet Calan; Arif Yuksel; Behnaz Aslanıpour; Murat Akşit; Giray Bozkaya
      Pages: 37 - 43
      Abstract: Publication date: January 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 1
      Author(s): Oktay Bilgir, Belma Gökçen, Ferda Bilgir, Aslı Guler, Mehmet Calan, Arif Yuksel, Behnaz Aslanıpour, Murat Akşit, Giray Bozkaya
      Background Growing evidence suggest that macrophage migration inhibitory factor (MIF) plays a vital role in glucose metabolism. We aimed to ascertain whether MIF levels are altered in subjects with prediabetes and also to determine the relationship between MIF and metabolic parameters as well as visceral fat mass. Material and Methods This cross-sectional study included 40 subjects with prediabetes and 40 age-, body mass index (BMI)- and sex-matched subjects with normal glucose tolerance. Circulating MIF levels were measured using enzyme-linked immunosorbent assay. Metabolic parameters of recruited subjects were evaluated. Visceral fat mass was measured using bioelectrical impedance method. Results Circulating MIF levels were found to be elevated in subjects with prediabetes compared to controls (26.46 ± 16.98 versus 17.44 ± 11.80 ng/mL, P = 0.007). MIF positively correlated with BMI, visceral fat mass and indirect indices of homeostasis model assessment of insulin resistance. In linear regression model, an independent association was found between MIF levels and metabolic parameters, including BMI, visceral fat mass and homeostasis model assessment of insulin resistance. Multivariate logistic regression analyses revealed that the odds ratio for prediabetes was higher in subjects in the highest quartile of MIF compared to those in the lowest quartile, after adjusting for potential confounders. Conclusions Increased MIF levels are associated with the elevation of prediabetic risk.

      PubDate: 2018-01-04T14:49:08Z
      DOI: 10.1016/j.amjms.2017.10.006
       
  • R-Wave Peak Time at Lead II in Adults With Ventricular Premature Beats,
           Bundle Branch Block and Left Anterior Fascicular Block
    • Authors: Min Yu; Tingting Chen; Shuang Hu; Shan Zou; Cantian Wang; Chujuan Zeng; Weijie Chen; Xuerui Tan
      Pages: 44 - 47
      Abstract: Publication date: January 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 1
      Author(s): Min Yu, Tingting Chen, Shuang Hu, Shan Zou, Cantian Wang, Chujuan Zeng, Weijie Chen, Xuerui Tan
      Background Recently, the R-wave peak time (RWPT) at lead II was reported to be a helpful and simple tool for differentiating wide QRS complex tachycardias with a RWPT ≥ 50ms for ventricular tachycardia diagnosis. Our previous study showed that the duration of RWPT at lead II in adults was ≈29ms. However, the effects of ventricular premature beats (VPBs), bundle branch block (BBB) or left anterior fascicular block (LAFB) on RWPT at lead II remain unknown. Methods The study was conducted in the First Affiliated Hospital of Shantou University Medical College in Southern China. Adults with VPBs, BBB or LAFB were included. RWPT at lead II was determined. Results Compared with the control groups, the right BBB, LAFB, RWPT were longer in groups with left BBB and VPBs. Compared with the group with left BBB, the group with VPBs had a significantly longer RWPT at lead II (54.20 ± 18.52 versus 84.76 ± 16.38ms, P < 0.01). Conclusion Our study showed that there is a significant difference in the RWPT at lead II between groups with left BBB, ventricular premature beat, right BBB and LAFB. A RWPT of 50ms may be optimal to differentiate between ventricular tachycardia and supraventricular tachycardia with right left BBB and LAFB, but not with left BBB.

      PubDate: 2018-01-04T14:49:08Z
      DOI: 10.1016/j.amjms.2017.08.017
       
  • Clinical Heterogeneity of Interstitial Lung Disease in Polymyositis and
           Dermatomyositis Patients With or Without Specific Autoantibodies
    • Authors: Fang Chen; Shanshan Li; Tao Wang; Jingli Shi; Guochun Wang
      Pages: 48 - 53
      Abstract: Publication date: January 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 1
      Author(s): Fang Chen, Shanshan Li, Tao Wang, Jingli Shi, Guochun Wang
      Background The aim of this study was to compare the heterogeneity of interstitial lung disease (ILD) in patients with polymyositis and dermatomyositis (PM/DM) according to serological type. Methods A total of 182 patients with PM/DM-ILD were observed retrospectively. Antiaminoacyl-tRNA synthetase (ARS) and antimelanoma differentiation-associated gene5 (MDA5) antibodies were screened using immunoblotting approach. The patients with ILD were divided into 3 groups: MDA5 (with anti-MDA5 antibody), ARS (with anti-ARS antibody) and MSN (without anti-MDA5 or anti-ARS antibody) group. Pulmonary features, treatment responses and prognoses were compared among the groups. Results A higher percentage of rapidly progressive ILD (RP-ILD) occurrences (55.8% versus 25% versus 16.9%, P < 0.001) was observed in the MDA5 group compared to ARS and MSN groups. The MSN group experienced lower dyspnea (48.2% versus 79% versus 71.4%, P = 0.001) and fever (18.1% versus 39.5% versus 37.5%, P = 0.01) frequencies compared to MDA5 and ARS groups. Response to 6-month treatment among 95 patients showed highest deterioration ratio (70%, P = 0.001) of ILD in the MDA5 group. Additionally, the highest frequency of ILD improvement (60%, P = 0.04) was observed in the ARS group. During the observation period, 24 patients died of respiratory failure. The 5-year survival rates were significantly lower in MDA5 group (50.2%) compared to ARS group (97.7%) or the MSN group (91.4%) (P < 0.001). Conclusions MDA5-ILD was associated with severe pulmonary manifestations, poor response to treatment and aggravated prognosis. The ARS-ILD group had favorable treatment response and prognosis. MSN-ILD patients had relatively worse treatment response and prognosis compared to the ARS group, even though they expressed milder pulmonary manifestation.

      PubDate: 2018-01-04T14:49:08Z
      DOI: 10.1016/j.amjms.2017.07.013
       
  • About a suggestive association between Fanconi Anemia and Laron Syndrome
    • Authors: I. Castilla-Cortazar; G.A. Aguirre; J.R. De Ita
      Abstract: Publication date: Available online 12 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): I. Castilla-Cortazar, G.A. Aguirre, J.R. De Ita


      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2018.02.004
       
  • Not All Gastric “Masses” Need a Biopsy - A Cautionary Tale
    • Authors: Divyansh Bajaj; Roni Manyevitch; Gordon Gray Still
      Abstract: Publication date: Available online 10 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Divyansh Bajaj, Roni Manyevitch, Gordon Gray Still


      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2018.02.002
       
  • Pegylated Interferon-α Plus Ribavirin Therapy Improves Left Ventricular
           Diastolic Dysfunction in Chronic Hepatitis C Patients Attaining Sustained
           Virological Response
    • Authors: Abdul-Quddus Mohammed; Ranshaka Auckle; Hai-Ling Li; Si-Ling Xu; Lu Liu; Dong-Dong Zhao; Wen-Liang Che
      Abstract: Publication date: Available online 9 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Abdul-Quddus Mohammed, Ranshaka Auckle, Hai-Ling Li, Si-Ling Xu, Lu Liu, Dong-Dong Zhao, Wen-Liang Che
      Background Pegylated interferon (pegIFN) in combination with ribavirin (RBV) has successfully improved the rate of sustained virological response (SVR) in chronic hepatitis c virus (HCV) infected individuals, which reduces the progression of the chronic liver disease. However, the influence of combination therapy (pegIFN/RBV) on cardiac function has yielded ambiguous results. The present study aimed to evaluate the effects of combination therapy with pegIFN/RBV on cardiac function of HCV-infected individuals with SVR. Materials and Methods Cardiac function was assessed and correlated in 142 treatment-naïve HCV-infected patients by determining cardiac biomarkers and echocardiography before treatment and 24 weeks post-treatment ( EOF). Results An SVR was achieved by 50.7% of all patients. Serum N-terminal pro-B-type natriuretic peptide levels were significantly higher in all patients before treatment and decreased significantly after EOF in the SVR group [62.84, (36.98-102.73) vs 22.87 (15.64-56.92) pg/mL, P<0.01]. Peak early diastolic annular velocity (E′) was significantly lower (7.69±2.48 vs 9.74±2.68 cm/s, P<0.001) and E/E′ was higher (10.04±2.51 vs 8.18±2.31, P<0.001) in all patients with SVR. However, there were no statistically significant differences in biomarkers and echocardiographic parameters for patients without SVR. In addition, multivariate analysis identified age (OR: 1.076, 95% CI [1.031-1.125], P<0.001), NT-proBNP (OR: 1.122, 95% CI [1.002-1.248], P=0.015), and SVR (OR: 0.532, 95% CI [0.214-0.895], P=0.023) as statistically significant independent variables associated with left ventricular diastolic dysfunction. Conclusions The present study showed no adverse effects of combination therapy on cardiac function of HCV-infected individuals with SVR. Subsequent viral eradication resulted in improvement of left ventricular diastolic dysfunction.

      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2018.02.001
       
  • Assessing the Burden of Abnormal LFTs and the Role of the Electronic
           Health Record: A Retrospective Study
    • Authors: Andrew D. Schreiner; Patrick D. Mauldin; William P. Moran; Valerie Durkalski-Mauldin; Jingwen Zhang; Samuel O. Schumann; Marc E. Heincelman; Justin Marsden; Don C. Rockey
      Abstract: Publication date: Available online 9 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Andrew D. Schreiner, Patrick D. Mauldin, William P. Moran, Valerie Durkalski-Mauldin, Jingwen Zhang, Samuel O. Schumann, Marc E. Heincelman, Justin Marsden, Don C. Rockey
      Introduction Primary care clinicians encounter abnormal liver function tests (LFTs) frequently. This study assesses the prevalence of abnormal LFTs and patient follow-up patterns in response. Methods This is a retrospective study from 2007 to 2016 of adult patients with abnormal LFTs seen in an internal medicine clinic. The proportion of patients with follow-up testing and the time (in days) to repeat LFTs were the primary outcomes measured. Results were evaluated before and after the implementation of the institution′s electronic health record (EHR). Results This study identified a period prevalence for abnormal LFTs of 39%. Of these, 9,545 unique patients met inclusion criteria, with 8,415 patients (88.2%) possessing follow-up LFTs and no significant difference in the proportion of patients receiving follow-up by degree of initial abnormality. Median time to follow-up in mild abnormalities (1–2 times normal) was 138 days, compared to 21 days for severe abnormalities (>4 times normal, p<0.0001). Reduced time to repeat testing across all spectrums of abnormality was observed following EHR implementation, but proportions of missing follow-up did not improve. A multivariable logistic regression model identified younger age, poverty, living over 50 miles from clinic, recent cohort entry, and a lower magnitude of abnormality as predictors for missing repeat LFT testing (c = 0.838 (95% CI: 0.827, 0.849)). Discussion Abnormal LFTs were detected in 39% of all patients seen. The degree of LFT abnormality did not influence rates of follow-up testing, but does appear to play a role in the timing of repeat testing, when obtained. Follow-up rates did not improve with EHR implementation.

      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2018.02.005
       
  • Editorial on "Cardiovascular Events in Alcoholic Syndrome with Alcohol
           Withdrawal History: Results from the National Inpatient Sample."
    • Authors: Hillary Johnston-Cox; Paul J. Mather
      Abstract: Publication date: Available online 6 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Hillary Johnston-Cox, Paul J. Mather


      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2018.01.016
       
  • The antiarrhythmic drug, Amiodarone, decreases AKT activity and sensitizes
           human acute myeloid leukemia cells to apoptosis by ABT-263
    • Authors: Corey J. Ketchem; Cory Kucera; Aditya Barve; Levi J. Beverly
      Abstract: Publication date: Available online 6 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Corey J. Ketchem, Cory Kucera, Aditya Barve, Levi J. Beverly
      Background Successful treatment of leukemia requires new medications to combat drug resistance, but the development of novel therapies is an arduous and risky endeavor. Repurposing currently approved drugs or those already in clinical development to treat other indications is a more practical approach. Moreover, combinatorial therapeutics are often more efficacious than single agent therapeutics because the former can simultaneously target multiple pathways that mitigate tumor aggressiveness and induce cancer cell death. Material and Methods In this study, we combined the class III antiarrhythmic agent amiodarone and the BH3 mimetic ABT-263 based on data from a prior drug screen to assess the degree of apoptotic induction in two human leukemia cell lines. Results The combination yielded statistically significant increases in apoptosis in both cell lines by downregulating AKT activity and increasing cleaved caspase-3. Conclusions Overall, our findings suggest that combining K+ channel blockers with prosurvival Bcl-2 family inhibitors is a promising therapeutic approach in treating leukemia.

      PubDate: 2018-02-15T19:03:23Z
      DOI: 10.1016/j.amjms.2018.01.011
       
  • Effects of different doses of irbesartan combined with spironolactone on
           urinary albumin excretion rate in elderly patients with early type 2
           diabetic nephropathy
    • Authors: Yingying Chen; Peng Liu; Xia Chen; Yanan Li; Fengmei Zhang; Yangang Wang
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Yingying Chen, Peng Liu, Xia Chen, Yanan Li, Fengmei Zhang, Yangang Wang
      Background: There is a lack of research on the effect of low-dose of Angiotensin receptor blockers (ARBs) combined with spironolactone, and the effect of high-dose of ARBs alone on urinary albumin excretion rate (UAER) in elderly patients with early type 2 diabetic nephropathy (DN). Methods We conducted a prospective randomized, open, parallel-controlled study that included 244 elderly patients with early DN and mild-to-moderate essential hypertension. Patients were randomly divided into 4 groups: low-dose irbesartan (group A), high-dose irbesartan (group B), low-dose irbesartan combined with spironolactone (group C) and high-dose irbesartan combined with spironolactone (group D). Changes in UAER, serum potassium and blood pressure were compared. Results There were no statistical differences in the baseline characteristics among groups. Furthermore, no significant difference in blood pressure before and after treatment was found among different groups. After 72-week treatment, UAER in group D was lower compared to group A and B (p<0.05). Meanwhile, compared with group B, UAER in group C decreased significantly (p<0.05). Additionally, significantly higher serum potassium was found in group D compared to other groups (p<0.05). Also, group D had the highest count of patients who withdrew from the study due to hyperkalemia compared to other groups (p<0.05). Conclusions Although high-dose irbesartan combined with spironolactone has been shown to be more efficient in reducing UAER in elderly patients with early DN, this treatment is very likely to cause hyperkalemia. In addition, low-dose irbesartan combined with spironolactone has been shown to be safer and more effective in decreasing UAER compared to high-dose irbesartan.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.017
       
  • The 50/10 oxygen-induced retinopathy model serves as a hyperoxia/hypoxia
           model of bronchopulmonary dysplasia
    • Authors: Huijuan Li; Ruyuan Zhu; Lijuan Qian; Wen Jin; Jiali Xie; Shumin Kang; Lijun Lu; Mingyu Tao; Li Jiang
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Huijuan Li, Ruyuan Zhu, Lijuan Qian, Wen Jin, Jiali Xie, Shumin Kang, Lijun Lu, Mingyu Tao, Li Jiang
      Background Animal models of bronchopulmonary dysplasia (BPD) are mainly created by hyperoxia exposure. However, these models do not fully recapitulate BPD pathophysiology as observed in clinical practice. To find a better BPD model, we established a rat 50/10 oxygen-induced retinopathy (OIR) model and analyzed the pathological features of the lungs. Methods The rat OIR model was established by exposing newborn rats (P0) to 50% or 10% oxygen (hyperoxia/hypoxia) on alternating days for 14 days. Lungs were harvested immediately on postnatal day 14 (P14) and on P18 after 4 days of normoxia exposure for hematoxylin and eosin (HE) staining, anti-alpha smooth muscle actin (α-SMA) immunohistochemistry (IHC), and Picrosirius red staining of collagen. Retinas were obtained to confirm successful model establishment by isolectin B4 staining of retinal vasculature. Results OIR rats presented with fewer and enlarged alveoli, and the septal walls were thicker than those in age-matched controls. α-SMA IHC indicated increased abundance of myofibroblasts in OIR rats. At P18, α-SMA-positive myofibroblasts were present at extremely low levels from the alveolar walls of control rats, while OIR rats showed myofibroblast persistence. The amount of collagen in OIR rats was also higher than that in control rats at both P14 and P18 as evidenced by Picrosirius red staining. Conclusions Alveolar changes observed by HE staining, prolonged and stronger α-SMA expression, and augmented collagen accumulation resemble the histopathology of BPD, suggesting that the rat 50/10 OIR model is suitable for use in BPD research.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.015
       
  • Letter to editor
    • Authors: Xinyi Zhu; Li Xiang; Tao You; Weiting Xu
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Xinyi Zhu, Li Xiang, Tao You, Weiting Xu


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.12.017
       
  • A Brain Ring-Enhancing Lesion
    • Authors: Mary Lindsey; Nancy Harrison; John Bridges; Jonathan Blossom; Shweta Kishore; Vikas Majithia
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Mary Lindsey, Nancy Harrison, John Bridges, Jonathan Blossom, Shweta Kishore, Vikas Majithia
      Neuropsychiatric systemic lupus erythematosus (NPSLE) presents a diagnostic challenge as there is no unified pathophysiologic process driving its presentation. Case reports are limited in detailing manifestations and outcomes of NPSLE. This case highlights a unique presentation of NPSLE and discusses challenges associated with diagnosis. A 27-year-old male with systemic lupus erythematosus presented with altered mentation. Initial laboratory results and computed tomography of the brain were unremarkable, but magnetic resonance imaging of the brain revealed ring-enhancing lesions reported as neurocysticercosis. This led to an extensive infectious disease evaluation, but ultimately there was no evidence of infection. The patient was diagnosed with NPSLE; treatment with intravenous glucocorticoids and cyclophosphamide led to dramatic clinical improvement. Repeat brain magnetic resonance imaging showed resolution of the ringed lesions. This case illustrates the importance of thorough evaluation in immunocompromised patients and warns of the risk of anchoring bias that can lead to diagnostic delays.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.009
       
  • A nest of worms in the eye
    • Authors: Huanhuan Cheng; Chunyun Wu; Juan Deng; Yingjie Liu
      Abstract: Publication date: Available online 2 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Huanhuan Cheng, Chunyun Wu, Juan Deng, Yingjie Liu


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.006
       
  • Chronic Alcohol Ingestion Impairs Rat Alveolar Macrophage Phagocytosis via
           Disruption of RAGE Signaling
    • Authors: Bashar S. Staitieh; Eduardo E. Egea; Xian Fan; Adaugo Amah; David M. Guidot
      Abstract: Publication date: Available online 1 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Bashar S. Staitieh, Eduardo E. Egea, Xian Fan, Adaugo Amah, David M. Guidot
      Background Alcohol significantly impairs antioxidant defenses and innate immune function in the lung and increases matrix metalloproteinase 9 (MMP-9) activity. The receptor for advanced glycation end products (RAGE) is a well-characterized marker of lung injury that is cleaved by MMP-9 into soluble RAGE and has not yet been examined in the alcoholic lung. We hypothesized that chronic alcohol ingestion would impair RAGE signaling via MMP-9 in the alveolar macrophage and thereby impair innate immune function. Methods Primary alveolar macrophages were isolated from control-fed or alcohol-fed rats. Real-time polymerase chain reaction (qRT-PCR), Western blotting, and enzyme-linked immunosorbent assays were performed to evaluate RAGE expression. Silencing of MMP-9 ribonucleic acid (RNA) in a rat alveolar macrophage cell line was confirmed by qRT-PCR and immunofluorescence (IF) was utilized to assess the association between alcohol, MMP-9, and RAGE. Phagocytosis was assessed using flow cytometry. Sulforaphane and glutathione were used to assess the relationship between oxidative stress and RAGE. Results RAGE messenger RNA expression was significantly increased in the alveolar macrophages of alcohol-fed rats, but IF showed membrane-bound RAGE protein expression was decreased. Lavage fluid demonstrated increased levels of soluble RAGE (sRAGE). Decreasing MMP-9 expression using si-MMP-9 abrogated the effects of alcohol on RAGE protein. Phagocytic function was suppressed by direct RAGE and the impairment was reversed by antioxidant treatment. Conclusions Chronic alcohol ingestion reduces RAGE protein expression and increases the amount of sRAGE in alveolar lavage fluid, likely via cleavage by MMP-9. In addition, it impairs phagocytic function. Antioxidants restore membrane-bound RAGE and phagocytic function.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.12.013
       
  • Infective Endocarditis in the Intravenous Drug User; Treatment
           Shortcomings
    • Authors: Alireza Movahed; William Schiavone
      Abstract: Publication date: Available online 1 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Alireza Movahed, William Schiavone


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.11.007
       
  • Prognostic Value of Ventricular Wall Motion Score and GRACE Score in Acute
           Mocardial Infarction Patients: Methodological Issues
    • Authors: Ahad Ashrafi-Asgarabad; Saeid Safiri
      Abstract: Publication date: Available online 1 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Ahad Ashrafi-Asgarabad, Saeid Safiri


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.12.018
       
  • Comparative effects of add-on pentoxifylline to losartan versus augmented
           dose losartan monotherapy on serum N-terminal pro-brain natriuretic
           peptide, serum highly sensitive C-reactive protein, and urinary albumin
           excretion rate in type 2 diabetes patients with nephropathy
    • Authors: Soghra Rabizadeh; Fatemeh Dehghani Firouzabadi; Sina Noshad; Sadaf Esteghamati; Mohsen Afarideh; Alireza Ghajar; Morsaleh Ganji; Mohammad Saadat; Behnam Heidari; Mohammad Taghi Najafi; Manouchehr Nakhjavani; Alireza Esteghamati
      Abstract: Publication date: Available online 1 February 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Soghra Rabizadeh, Fatemeh Dehghani Firouzabadi, Sina Noshad, Sadaf Esteghamati, Mohsen Afarideh, Alireza Ghajar, Morsaleh Ganji, Mohammad Saadat, Behnam Heidari, Mohammad Taghi Najafi, Manouchehr Nakhjavani, Alireza Esteghamati
      Background This study was designed to comparatively assess the effects of add-on pentoxifylline to losartan vs. increasing the dose of losartan on serum N-terminal pro-brain natriuretic peptide (NT-proBNP), serum highly sensitive C-reactive protein (hsCRP), and the urinary albumin excretion (UAE) rate in patients with type 2 diabetes and nephropathy. Methods In an open-label, single-center, parallel-group, randomized clinical trial (NCT03006952), 30 patients received BD dose of pentoxifylline 400mg plus daily dose of losartan 50mg (pentoxifylline arm) and 29 patients received BD dose of losartan 50mg (losartan arm) during a 12-week follow-up period. Results Serum NT-proBNP, serum hsCRP, and UAE levels all significantly decreased from baseline in both trial arms. The pentoxifylline and losartan trial arms were equally effective in reducing serum NT-proBNP levels during the course of trial (multivariable adjusted model p value = 0.864, effect size = 0.2%). There was a greater decrease in UAE and serum hsCRP levels in the pentoxifylline arm (p = 0.034, effect size = 7.8%; p = 0.009, effect size = 11.7%, respectively). Conversely, patients in the losartan arm achieved better systolic and diastolic blood pressure control (p < 0.001, effect size = 25.4%; p = 0.010, effect size = 11.3%, respectively). Conclusions Circulating NT-proBNP levels equally and significantly reduced from baseline in pentoxifylline and losartan treatment arms, in parallel with comparatively superior decreases of UAE and serum hsCRP in the pentoxifylline arm, and larger decreases of systolic and diastolic blood pressures in the losartan arm.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2017.12.015
       
  • Can Focal Segmental Glomerulosclerosis be Differentiated from Minimal
           Change Nephrotic Syndrome Using Biomarkers'
    • Authors: Keiko Hosohata
      Abstract: Publication date: Available online 31 January 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Keiko Hosohata


      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.003
       
  • MicroRNA-140 suppresses human chondrocytes hypertrophy by targeting SMAD1
           and controlling the bone morphogenetic protein pathway in osteoarthritis
    • Authors: Canfeng Li; Qinshen Hu; Zhuo Chen; Bin Shen; Jing Yang; Pengde Kang; Zongke Zhou; Fuxing Pei
      Abstract: Publication date: Available online 31 January 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Canfeng Li, Qinshen Hu, Zhuo Chen, Bin Shen, Jing Yang, Pengde Kang, Zongke Zhou, Fuxing Pei
      Background This study aimed to investigate the expression levels and relationship of bone morphogenetic proteins (BMPs) signaling molecules and microRNA-140 (miR-140) in human osteoarthritis (OA) chondrocytes. Materials and Methods Different stage chondrocytes (normal cartilage, mid-stage OA, advanced-stage OA) were isolated from cartilage samples according to Kellgren and Lawrence criteria. The effect of miR-140 on BMPs signaling was evaluated by transfecting miR-140 mimic or inhibitor into chondrocytes. The expression of responsive genes was measured using real-time polymerase chain reaction (PCR) and Western blotting analysis. Results There was a significant reduction in miR-140 and SOX9 expression in OA groups compared to the normal group, and there was a further reduction in the severe OA group than the moderate OA group. Compared with the normal group, the expression of ALK1, SMAD1, COL10A1 and MMP3 was higher in the OA groups, while the expression of COL2A1 was lower in the OA groups. In the moderate OA group, transfection with miR-140 mimic increased SMAD1, SOX9 and COL2A1 expression, but decreased COL10A1 expression. However, there was an opposite effect after transfecting miR-140 inhibitor with decreased SMAD1, SOX9 and COL2A1 expression, and increased COL10A1 expression. Interestingly, the biological effect of transfecting miR-140 mimic or inhibitor was similar in the severe OA group. SMAD1 and COL2A1 protein production followed the same pattern as their expression profile. Conclusions miR-140 suppresses chondrocytes hypertrophy by controlling the BMPs signaling pathway, which highlights the importance of miR-140 in the maintenance of chondrocyte homeostasis and opens up novel avenues in OA therapeutic strategies.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.004
       
  • Cardiovascular Events in Alcoholic Syndrome with Alcohol Withdrawal
           History: Results from the National Inpatient Sample
    • Authors: P. Krishnamoorthy; A. Kalla; V.M. Figueredo
      Abstract: Publication date: Available online 31 January 2018
      Source:The American Journal of the Medical Sciences
      Author(s): P. Krishnamoorthy, A. Kalla, V.M. Figueredo
      Background Epidemiological studies suggest reduced cardiovascular disease (CVD) events with moderate alcohol consumption. However, heavy and binge drinking may be associated with higher CVD risk. Utilizing the Nationwide Inpatient Sample, we studied the association between a troublesome alcohol history (TAH), defined as those with diagnoses of both chronic alcohol syndrome and acute withdrawal history, and CVD events. Methods Patients >18 years with diagnoses of both chronic alcohol syndrome and acute withdrawal using the International Classification of Diseases-Ninth Edition-Clinical Modification (ICD-9-CM) codes 303.9 and 291.81, were identified in the Nationwide Inpatient Sample 2009–2010 database. Demographics, including age and sex, and CVD event rates were collected. Results TAH patients were more likely to be male, with a smoking history, and have hypertension, with less diabetes, hyperlipidemia, and obesity. After multimodal adjusted regression analysis, odds of coronary artery disease, acute coronary syndrome, in-hospital death, and heart failure were significantly lower in TAH patients when compared to the general discharge patient population. Conclusions Utilizing a large inpatient database, TAH patients had a significantly lower prevalence of CVD events, even after adjusting for demographic and traditional risk factors, despite higher tobacco use and male sex predominance, when compared to the general patient population.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.005
       
  • Anti-thrombotic therapy in Non-Valvular Atrial Fibrillation: Consensus and
           Challenges
    • Authors: Furqan Khattak; Mian B. Alam; Timir K Paul; Shasank Rijal; Shoaib Wazir; Carl J. Lavie; Samir Saba
      Abstract: Publication date: Available online 31 January 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Furqan Khattak, Mian B. Alam, Timir K Paul, Shasank Rijal, Shoaib Wazir, Carl J. Lavie, Samir Saba
      Atrial fibrillation (AF) is associated with high risk of systemic thromboembolism leading to significant morbidity and mortality. Warfarin, previously the mainstay for stroke prevention in AF, requires close monitoring because of multiple food and drug interactions. In recent years, Food and Drug Administration has approved several Direct Oral Anticoagulants (DOACs) for use in patients with non-valvular AF. These agents have not been studied in AF patients with valvular AF who are at an even higher risk of systemic thromboembolism. DOACs do not require frequent blood testing or changes in dosage except when renal function deteriorates, however, the lack of established antidotes for many of these agents remains a challenge. Also, currently there is no head-to-head comparison between these agents to guide clinical choice. This article discusses the advantages and disadvantages of currently approved oral anticoagulants in non-valvular AF, with a special emphasis on the DOACs and their individual characteristics.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.013
       
  • Recurrent Severe Hypoinsulinemic Hypoglycemia Responsive to Temozolomide
           And Bevacizumab In A Patient With Doege-Potter Syndrome
    • Authors: Amie A. Ogunsakin; Holly L. Hilsenbeck; David C. Portnoy; Ebenezer A. Nyenwe
      Abstract: Publication date: Available online 31 January 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Amie A. Ogunsakin, Holly L. Hilsenbeck, David C. Portnoy, Ebenezer A. Nyenwe
      Non-islet cell tumor hypoglycemia is rare. We highlight the diagnosis and treatment of recurrent severe hypoglycemia in a 49-year old woman with malignant solitary fibrous tumor of the pleura (Doege-Potter syndrome). The clinical, laboratory, and radiologic findings of the case are presented and a brief literature review is provided. Of note, imaging studies showed a large mass in the right hemithorax and pathology and immuno-histochemical stains confirmed a malignant solitary fibrous tumor of the pleura. She was a poor surgical candidate due to a large tumor burden. She was treated with a combination of temozolomide and bevacizumab to which she responded with resolution of hypoglycemia. The treatment of choice for hypoglycemia in patients with the Doege-Potter syndrome is surgical excision. We here report that a combination of temozolomide and bevacizumab may be a viable option in patients with inoperable disease.

      PubDate: 2018-02-05T13:55:04Z
      DOI: 10.1016/j.amjms.2018.01.008
       
  • Fatal Hepatotoxicity Due to Viaminate
    • Authors: Hui Zhang; Ji Zhang; Hongmei Dong
      Abstract: Publication date: Available online 6 January 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Hui Zhang, Ji Zhang, Hongmei Dong
      Viaminate is a derivative of retinoic acid (tretinoin) used in the treatment of severe acne and other disorders of keratinization. Liver dysfunction due to viaminate therapy has not been well described and there is no report of death due to viaminate-induced hepatotoxicity. Herein, we report the case of a woman who underwent treatment at the hospital for 38 days and died of hepatic failure after taking viaminate for more than two months. This case provides further insight into viaminate-induced hepatotoxicity.

      PubDate: 2018-01-09T16:55:14Z
      DOI: 10.1016/j.amjms.2018.01.001
       
  • Effects of Alpinetin On Intestinal Barrier Function, Inflammation and
           Oxidative Stress in Dextran Sulfate Sodium-Induced Ulcerative Colitis Mice
           
    • Authors: Yue Tan; Changqing Zheng
      Abstract: Publication date: Available online 6 January 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Yue Tan, Changqing Zheng
      Objective Alpinetin is a flavonoid isolated from Alpinia katsumadai Hayata that has demonstrated anti-inflammatory, antibacterial and anti-tumor activities. However, alpinetin has not been widely studied in amelioration of inflammatory bowel disease. The study aimed to investigate the role of alpinetin on intestinal epithelial tight junctions, oxidative stress and Nrf2/HO-1 signaling pathway in dextran sulfate sodium (DSS)-induced ulcerative colitis (UC) in mice. Methods A total of 40 mice were divided into 5 groups (n=8/group): control group, DSS group (received 3% DSS), and low, medium and high dose treatment groups (3% DSS + alpinetin 25, 50 and 100mg/kg). The disease activity index (DAI), histological scores, epithelial tight junctions, oxidative stress factors, and Nrf2/HO-1 signaling pathway in the colon were determined. Results Alpinetin improved DAI, colonic shortening, histological scores, and myeloperoxidase activity compared with the DSS group. The expression of occludin and zonula occludens-1 were upregulated by alpinetin, while the expression of claudin-2 was reduced. Moreover, alpinetin inhibited the level of malondialdehyde, and increased the level of superoxide dismutase. Nrf2/HO-1 signaling pathways were also found to be activated. Conclusion Alpinetin is associated with decreased intestinal inflammation and oxidative stress dose-dependently; also regulate the expression of tight junction between cells in UC mice. The findings of our study may shed light on the better treatment of UC by using alpinetin.

      PubDate: 2018-01-09T16:55:14Z
      DOI: 10.1016/j.amjms.2018.01.002
       
  • Heimlich Maneuver Induced Diaphragmatic Rupture and Hiatal Hernia
    • Authors: Andrew Herman; Abhishek Maiti; Sujith V. Cherian; Rosa M. Estrada-Y-Martin
      Abstract: Publication date: Available online 6 January 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Andrew Herman, Abhishek Maiti, Sujith V. Cherian, Rosa M. Estrada-Y-Martin


      PubDate: 2018-01-09T16:55:14Z
      DOI: 10.1016/j.amjms.2017.11.009
       
  • 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
       
 
 
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