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Publisher: Elsevier   (Total: 3043 journals)

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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 331, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, 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: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
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: 35, 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: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 343, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 307, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, 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: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, 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: 11)
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: 157, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover American Journal of the Medical Sciences
  [SJR: 0.653]   [H-I: 70]   [12 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9629
   Published by Elsevier Homepage  [3043 journals]
  • Why Do Clinicians Need to Study the History of Medicine and Why Should
           This Journal Publish Articles About It'
    • Authors: Edward C. Halperin
      Pages: 1 - 2
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Edward C. Halperin


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.06.010
       
  • Biomarkers in Sepsis: On Target or Off the Mark'
    • Authors: Jenny E. Han; Greg S. Martin
      Pages: 3 - 4
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Jenny E. Han, Greg S. Martin


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.06.008
       
  • Hepatitis C Viral Infection and Porphyria Cutanea Tarda
    • Authors: Jeffrey P. Callen
      Pages: 5 - 6
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Jeffrey P. Callen


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.06.009
       
  • Vascular Damage and Kidney Transplant Outcomes: An Unfriendly and Harmful
           Link
    • Authors: Domingo Hernández; Javier Triñanes; Ana María Armas; Pedro Ruiz-Esteban; Juana Alonso-Titos; Ana Duarte; Miguel González-Molina; Eulalia Palma; Eduardo Salido; Armando Torres
      Pages: 7 - 16
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Domingo Hernández, Javier Triñanes, Ana María Armas, Pedro Ruiz-Esteban, Juana Alonso-Titos, Ana Duarte, Miguel González-Molina, Eulalia Palma, Eduardo Salido, Armando Torres
      Kidney transplant (KT) is the treatment of choice for most patients with chronic kidney disease, but this has a high cardiovascular mortality due to traditional and nontraditional risk factors, including vascular calcification. Inflammation could precede the appearance of artery wall lesions, leading to arteriosclerosis and clinical and subclinical atherosclerosis in these patients. Additionally, mineral metabolism disorders and activation of the renin-angiotensin system could contribute to this vascular damage. Thus, understanding the vascular lesions that occur in KT recipients and the pathogenic mechanisms involved in their development could be crucial to optimize the therapeutic management and outcomes in survival of this population. This review focuses on the following issues: (1) epidemiological data framing the problem; (2) atheromatosis in KT patients: subclinical and clinical atheromatosis, involving ischemic heart disease, congestive heart failure, stroke and peripheral vascular disease; (3) arteriosclerosis and vascular calcifications; and (4) potential pathogenic mechanisms and their therapeutic targets.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.01.004
       
  • The Underappreciated Doctors of The American Civil Rights Movement. Part
           I: Theodore Roosevelt Mason Howard, MD
    • Authors: Richard D. deShazo; Sara B. Parker
      Pages: 17 - 21
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Richard D. deShazo, Sara B. Parker
      During the fight to end segregation in the United States, most of the 25 or so black physicians who had not already left Mississippi took risks to become active in civil rights locally and nationally. One of the first was T.R.M. Howard, MD, whose life story is both an encouragement and warning for today's physicians. Howard, the protégé of a white Adventist physician, became active in civil rights during medical school. While serving as chief surgeon of the all-black hospital in Mississippi, he formed his own civil rights organization in 1951 and worked to solve the shootings of 2 of its members, George Lee and Gus Courts, and the murder of Emmett Till in 1955. His reports of these events and collaborations with other civil rights icons helped trigger the modern civil rights movement. At the same time, he became a nationally known proponent of abortion rights and then fled to Chicago in 1956, after arming his Delta mansion with long guns and a Thompson machine gun. Howard will be remembered for many things, including his activism for the social determinants of health as president of the National Medical Association.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.05.017
       
  • Plasma Antiphospholipid Antibodies Effects on Activated Partial
           Thromboplastin Time Assays
    • Authors: Ke Yao; Lingyun Zhang; Hang Zhou; Ning Tang; Dengju Li
      Pages: 22 - 26
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Ke Yao, Lingyun Zhang, Hang Zhou, Ning Tang, Dengju Li
      Background Activated partial thromboplastin time (aPTT) assays can be affected by plasma antiphospholipid antibodies (aPLs), but the degree of the interference is not easy to predict. This study aimed to investigate the effects on aPTT assay results of different types and combinations of aPLs, including anti-β2-glycoprotein I antibodies, anticardiolipin antibodies and lupus anticoagulant. Materials and Methods We retrospectively collected clinical information and laboratory tests from aPL-positive patients. The potential influence of aPLs on aPTT assays was assessed. Results The survey included 589 aPL-positive patients. No significant differences existed in basic characteristics such as sex, age, prothrombin time, fibrinogen and alanine aminotransferase among different cases with 1, 2 or 3 types of positive-aPL markers (P > 0.05). In 113 patients with abnormal aPTT values, multivariable linear regression analysis showed a significant correlation between an abnormal degree of aPTT values and dilute Russell viper venom time (dRVVT) or silica clotting time (SCT) with a correlation coefficient of 0.437 or 0.497 (P < 0.01), whereas age, anticardiolipin antibodies-immunoglobulin G, anticardiolipin antibodies-immunoglobulin M and anti-β2-glycoprotein I antibodies were of no significance (P > 0.05). Among blood samples with 3 types of aPLs positivity, the rate of abnormal aPTT detection values was 55.3%, which was significantly higher than that observed in patients with negative, single-positive or double-positive aPL markers (P < 0.05). Patients with a moderate to strong dRVVT or SCT had a higher proportion of abnormal aPTT assays than did patients with a low dRVVT or SCT (P < 0.05). Conclusions When abnormal aPTT values are obtained, the influence of aPLs should be considered, especially in the presence of a moderate to strong dRVVT or SCT.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.03.031
       
  • Prognostic Value of Ventricular Wall Motion Score and Global Registry of
           Acute Coronary Events Score in Patients With Acute Myocardial Infarction
    • Authors: Li Xiang; Maosong Wang; Tao You; Yang Jiao; Jianchang Chen; Weiting Xu
      Pages: 27 - 32
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Li Xiang, Maosong Wang, Tao You, Yang Jiao, Jianchang Chen, Weiting Xu
      Objective The aim of this study was to evaluate the prognostic values of ventricular wall motion score (WMS) and Global Registry of Acute Coronary Events (GRACE) score in patients with acute myocardial infarction (AMI) in a 12-month single-center prospective cohort. Materials and Methods Consecutive inpatients diagnosed with AMI in the Department of Cardiology of The Second Affiliated Hospital of Soochow University from September 2012 through March 2015 were enrolled in this study. Echocardiography was issued to all subjects to calculate WMS within 24 hours after admission, and GRACE score of each patient was obtained simultaneously. During a 12-month follow-up period, all major adverse cardiac events (MACE) were recorded. Results After 12 months of observation, 124 of 635 patients with AMI developed MACE. The WMS (23.70 ± 3.80 versus 20.47 ± 3.25) and GRACE score (185.59 ± 45.16 versus 152.19 ± 36.51) were significantly higher in patients with MACE than those without MACE (P < 0.05). Survival analysis using Cox regression revealed that both WMS (95% CI: 1.082-1.184, P < 0.05) and GRACE score (95% CI: 1.010-1.021, P < 0.05) independently predicted MACE. The receiver operating curve curve analysis showed that the area under curve of WMS, GRACE score and the combination of WMS and GRACE score were 0.768 (P < 0.05), 0.718 (P < 0.05) and 0.812 (P < 0.05), respectively. Conclusions WMS and GRACE score were independent predictors of MACE in patients with AMI in 12-month follow-up, and the combined application of WMS and GRACE score can significantly improve the predictive value.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.03.029
       
  • Is Decreased Mean Platelet Volume in Allergic Airway Diseases Associated
           With Extent of the Inflammation Area'
    • Authors: Recep Akgedik; Yasin Yağız
      Pages: 33 - 38
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Recep Akgedik, Yasin Yağız
      Objective The aim of this study was to determine the relationship between mean platelet volume (MPV) level and the extent of airway inflammation in allergic airway diseases and in subgroups by comparison of inflammatory markers. Materials and Methods A retrospective examination was made of 250 patients with allergic airway disease in the symptomatic phase, who had been newly diagnosed or who had abandoned treatment for at least 6 months. These patients were separated into 3 groups of asthma without allergic rhinitis (A − AR, n = 107), asthma with allergic rhinitis (A + AR, n = 83) and allergic rhinitis without asthma (AR − A, n = 60). Results The MPV values of the study groups were found to be significantly lower than those of the control group (P < 0.001). MPV was determined to be negatively correlated with white blood cells, neutrophil count, platelet count and immunoglobulin E level in the study groups. The lowest MPV value was determined in the A + AR group (8.035 ± 1.05fL), which had the most extensive airway involvement, and the highest MPV value was determined in the AR − A group (8.109 ± 1.11fL) with the least airway involvement. MPV level sensitivity and the specificity of the best cutoff level were 74.5% and 40.8%, respectively. The cutoff level of 8.18fL for MPV level was found to have moderate sensitivity and low specificity for predicting pulmonary embolism. Conclusions The results of this study showed that MPV is lower in allergic airway diseases and a negative correlation was determined between MPV and inflammation markers but no statistically significant difference was determined between MPV and extent of the inflammation area.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.04.001
       
  • Potential Value of Coagulation Parameters for Suggesting Preeclampsia
           During the Third Trimester of Pregnancy
    • Authors: Ying Chen; Li Lin
      Pages: 39 - 43
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Ying Chen, Li Lin
      Background Preeclampsia is a relatively common complication of pregnancy and considered to be associated with different degrees of coagulation dysfunction. This study was developed to evaluate the potential value of coagulation parameters for suggesting preeclampsia during the third trimester of pregnancy. Materials and Methods Data from 188 healthy pregnant women, 125 patients with preeclampsia in the third trimester and 120 age-matched nonpregnant women were analyzed. Prothrombin time, prothrombin activity, activated partial thromboplastin time, fibrinogen (Fg), antithrombin, platelet count, mean platelet volume, platelet distribution width and plateletcrit were tested. Results All parameters, excluding prothrombin time, platelet distribution width and plateletcrit, differed significantly between healthy pregnant women and those with preeclampsia. Platelet count, antithrombin and Fg were significantly lower and mean platelet volume and prothrombin activity were significantly higher in patients with preeclampsia (P < 0.001). Among these parameters, the largest area under the receiver operating characteristic curve for preeclampsia was 0.872 for Fg with an optimal cutoff value of ≤2.87g/L (sensitivity = 0.68 and specificity = 0.98). For severe preeclampsia, the area under the curve for Fg reached up to 0.922 with the same optimal cutoff value (sensitivity = 0.84, specificity = 0.98, positive predictive value = 0.96 and negative predictive value = 0.93). Conclusions Fg is a biomarker suggestive of preeclampsia in the third trimester of pregnancy, and our data provide a potential cutoff value of Fg ≤ 2.87g/L for screening preeclampsia, especially severe preeclampsia.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.03.012
       
  • The Urinothorax: A Comprehensive Review With Case Series
    • Authors: Adam Austin; Sidharth Navin Jogani; Paul Bradley Brasher; Rahul Gupta Argula; John Terrill Huggins; Amit Chopra
      Pages: 44 - 53
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Adam Austin, Sidharth Navin Jogani, Paul Bradley Brasher, Rahul Gupta Argula, John Terrill Huggins, Amit Chopra
      Urinothorax is an uncommon thoracic complication of genitourinary (GU) tract disease, which is most frequently caused by obstructive uropathy, but may also occur as a result of iatrogenic or traumatic GU injury. It is underrecognized because of a perceived notion as to the rarity of the diagnosis and the absence of established diagnostic criteria. Urinothorax is typically described as a paucicellular, transudative pleural effusion with a pleural fluid/serum creatinine ratio >1.0. It is the only transudate associated with pleural fluid acidosis (pH < 7.40). When the pleural fluid analysis demonstrates features of a transudate, pH <7.40 and a pleural fluid/serum creatinine ratio >1.0, a confident clinical diagnosis of urinothorax can be established. A technetium 99m renal scan can be considered a confirmatory test in patients who lack the typical pleural fluid analysis features or fail to demonstrate evidence of obstructive uropathy that can be identified via conventional radiographic modalities. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying GU tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.03.034
       
  • Epigallocatechin-3-Gallate: The Prospective Targeting of Cancer Stem Cells
           and Preventing Metastasis of Chemically-Induced Mammary Cancer in Rats
    • Authors: Sahar S. Abd El-Rahman; Gehan Shehab; Heba Nashaat
      Pages: 54 - 63
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Sahar S. Abd El-Rahman, Gehan Shehab, Heba Nashaat
      Background Cancer stem cells are a subpopulation of tumor cells that are capable of self-renewal, capable of tumor recurrence and metastasis, and in addition are resistant to current cancer therapies. Epigallocatechin-3-gallate is a type of catechin found in green tea that is known for its powerful chemoprotective ability. Hence, this study aimed to investigate the effect of epigallocatechin-3-gallate on 7, 12 dimethylbenzanthracene-induced tumor metastasis, angiogenesis and cancer stem cells. Materials and Methods For this purpose, 3 groups of virgin femal rats with 7,12 dimethylbenzanthracene-induced mammary cancer were treated using epigallocatechin-3-gallate, paclitaxel or their combination. Results It was found that epigallocatechin-3-gallate exhibited significant chemopreventive effects and anti-cancer stem cell activity through several pathways, including a significant decrease in the size and number of tumors per rat, significant amelioration of the oxidative stress markers’ alterations and significant inhibition of CD44, VEGF, Ki-67 and MMP-2 expression associated with a significantly increased expression of caspase-3. Histopathologically, therapy with epigallocatechin-3-gallate resulted in marked necrosis of the neoplastic cells and the tumor masses were mostly replaced by proliferated fibrous tissue so that histological confirmation of a previous tumor was not possible at that site. However, in the combination therapy the neoplastic cells showed marked vacuolation, haphazard arrangement and extensive nuclear pyknosis accompanied with many apoptotic bodies. Therapy with the sole paclitaxel caused variable degrees of necrosis among the neoplastic cells. Additionally, the combination of epigallocatechin-3-gallate and paclitaxel significantly enhanced the later anticancer efficacy. Conclusions Epigallocatechin-3-gallatecould be offered as an unprecedented curative strategy to eradicate cancer.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.03.001
       
  • Pancreatic Head Actinomycosis
    • Authors: Zhamak Khorgami; Charles Anthony Howard; Guido M. Sclabas
      Pages: 64 - 65
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Zhamak Khorgami, Charles Anthony Howard, Guido M. Sclabas


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2016.09.015
       
  • Multiple Endocrine and Neoplastic Diseases After Unsuccessful Treatment of
           Hepatitis C With Interferon and Ribavirin
    • Authors: Shirin Attarian; Janaki Sharma; Andreas Kaubisch; Joel Zonszein; Missak Haigentz
      First page: 66
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Shirin Attarian, Janaki Sharma, Andreas Kaubisch, Joel Zonszein, Missak Haigentz


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2016.10.001
       
  • Scimitar Syndrome With an Absent Right Upper Lung Lobe
    • Authors: Recep Akgedik; Ali Bekir Kurt; Zeki Yuksel Gunaydin
      First page: 67
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Recep Akgedik, Ali Bekir Kurt, Zeki Yuksel Gunaydin


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2016.11.016
       
  • Plasmodium falciparum Exflagellation in a Patient With Ovalocytosis
    • Authors: Mamadou Alpha Diallo; Khadim Diongue; Daouda Ndiaye
      First page: 68
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Mamadou Alpha Diallo, Khadim Diongue, Daouda Ndiaye


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.04.013
       
  • Triple Threat in Infective Endocarditis: A Fatal Combo
    • Authors: Priyadarshini Loganathan; Mahesh Gajendran
      First page: 69
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Priyadarshini Loganathan, Mahesh Gajendran


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2016.12.021
       
  • Gastric Kaposi’s Sarcoma
    • Authors: Raghav Bansal; Christopher Tomaino; Joel Baum
      First page: 70
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Raghav Bansal, Christopher Tomaino, Joel Baum


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2016.12.016
       
  • A Canine Kidney Conundrum
    • Authors: Juan Carlos Q. Velez
      Pages: 71 - 73
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Juan Carlos Q. Velez


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2016.08.021
       
  • Presentation of 2017 SSCI Founders’ Medal
    • Authors: Jesse Roman; Sushma K. Cribbs
      Pages: 75 - 77
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): Jesse Roman, Sushma K. Cribbs


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.03.018
       
  • 2017 Founders’ Medal Acceptance
    • Authors: David M. Guidot
      Pages: 78 - 80
      Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1
      Author(s): David M. Guidot


      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.03.017
       
  • Sporadic Fundic Gland Polyps and Level of Gastric Acid Suppression
    • Authors: Mohamed H. Khalaf; Andrew Brock; Donald O. Castell
      Abstract: Publication date: Available online 27 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Mohamed Khalaf, Andrew S. Brock, Donald Castell
      Background Fundic gland polyps (FGPs) are a common endoscopic finding and are known to be associated with proton pump inhibitors (PPIs) use. It is not known if their prevalence is affected by gastric acidity levels. This study aimed to assess whether there is a correlation between FGPs and gastric acidity levels as identified on 24 hour ambulatory impedance pH studies in patients on PPI therapy. Methods We performed a review of 402 consecutive patients who take at least once daily PPI and underwent esophagogastroduodenoscopy (EGD) with combined impedance-pH (Imp-pH) studies in the same setting (time and place) between January 2010 and December 2014. Patients were classified into 2 groups based on the presence or absence of biopsy-confirmed FGPs during endoscopy. Results Of the 402 patients, 30 (7%) had FGPs. One of these polyps was found with low grade dysplasia. No significant difference of the distributions of the [H+] in the FGPs vs the non-polyp groups (p= 0.741). There was no significant difference between the 2 groups regarding PPI dose frequency regimens (once and twice) (P = 0.074). However, we found weak ordinal association with PPI duration (p=0.01) (Spearman=0.1). Conclusions FGPs are common endoscopic lesions. Incidence of dysplasia in FGPs is not only rare, but also of unknown clinical significance. While they seem to be associated with PPIs, the mechanism remains unclear as we found no correlation between the presence of FGPs and gastric acid control or PPI dose. Future studies would be useful to elucidate an alternate mechanism.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/s0016-5085(17)31767-5
       
  • 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
      Abstract: Publication date: Available online 4 August 2017
      Source:The American Journal of the Medical Sciences
      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 clinic 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 & 3, 6 (6.2%) Group 4, and 1 (1%) Group 5 patients. Group 1 patients were treated with PAH specific drug, and twelve 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 &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: 2017-08-09T12:39:11Z
      DOI: 10.1016/j.amjms.2017.07.008
       
  • 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
      Abstract: Publication date: Available online 3 August 2017
      Source:The American Journal of the Medical Sciences
      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 de-compensation (AD). Methods We performed a prospective, observational cohort study consisting of 492 cirrhotic patients with AD at our center from February 2014 to Mach 2015. Clinical, laboratory, and survival data of 492 patients with cirrhosis and AD 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: HR=1.60; 95% CI, 1.07–2.41; p=0.023 and 2 year: HR=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, while invasive minor surgical procedures with ACLF throughout the hospital stay and high CLIF-SOFA scores were associated with nosocomial BIs. Conclusions CA/HCA BIs were associated with increased long-term mortality in cirrhosis patients with AD, while nosocomial BIs may be related to poor short-term prognosis.

      PubDate: 2017-08-09T12:39:11Z
      DOI: 10.1016/j.amjms.2017.08.003
       
  • Recurrent Pyroglutamic Acidosis Related to Therapeutic Acetaminophen
    • Authors: Hazem M. Alhourani; Aneel Kumar; Lekha K. George; Tahira Sarwar; Barry M. Wall
      Abstract: Publication date: Available online 3 August 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Hazem M. Alhourani, Aneel Kumar, Lekha K. George, Tahira Sarwar, Barry M. Wall


      PubDate: 2017-08-09T12:39:11Z
      DOI: 10.1016/j.amjms.2017.08.001
       
  • A Study of Novel siRNA Targeting Survivin Delivered by Nanoparticles
    • Authors: Chen Feng; Tianyou Wang; Yi Zhang; Kuiyao Qu; Suoqin Tang
      Abstract: Publication date: Available online 3 August 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Chen Feng, Tianyou Wang, Yi Zhang, Kuiyao Qu, Suoqin Tang
      Background The aim of present study was to investigate antitumor effect of our novel survivin siRNA nanoliposomes on xenograft mouse models with human cervical carcinoma HeLa cells, and to evaluate pharmacokinetics. Materials and Methods Survivin-targeted siRNA nanoliposome was prepared and transfected into xenograft mouse models. Tumor growth in mice was determined, and survivin expression was analyzed by using histological and immunohischemical staining. Furthermore, low, moderate and high dose of survivin siRNA nanoliposomes were injected in three groups, and plasma concentrations were detected at various time points by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Biodistribution of siRNA in tumor and other important organs were also determined. Results Survivin expression was significantly downregulated by survivin siRNA delivery-mediated by nanoliposome, along with significant suppression of cell growth. Peak concentrations were obtained at 15minutes after injection in each group, with 1,042,538.00, 6,837,099.54 and 14,631,333.15pg/ml, respectively, and the plasma concentration decreased significantly after 24hours. The half-time life of survivin siRNA nanoliposomes in each group was 3.60, 2.64, and 2.80hours, respectively. The AUC values were 952,190.88, 6,800,687.79, and 13,803,680.96h·pg/ml, and the total drug clearance were 1050.12, 441.13, and 434.67ml/h/kg. A significant accumulation of Cy5-labeled siRNA was found in the tumor, and a nonspecific accumulation was reduced significantly in lung. Conclusions Our finding revealed that survivin suppression by siRNA may contribute to tumor inhibition through both proliferation inhibition and apoptosis promotion effect, and the pharmacokinetic characteristics serve as a fundamental role for further studies on its applicability for cancer therapy.

      PubDate: 2017-08-09T12:39:11Z
      DOI: 10.1016/j.amjms.2017.08.002
       
  • 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
      Abstract: Publication date: Available online 2 August 2017
      Source:The American Journal of the Medical Sciences
      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 182 patients with PM/DM-ILD were observed retrospectively. Anti-aminoacyl-tRNA synthetase (ARS) and anti-melanoma differentiation-associated gene5 (MDA5) antibodies were screened using immunoblotting approach. The ILD patients were divided into 3groups: 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 Higher percentage of rapidly progressive ILD (RP-ILD) occurrences (55.8% vs. 25% vs. 16.9%, p<0.001) was observed in the MDA5 group compared to ARS and MSN groups. MSN group experienced lower dyspnea (48.2% vs. 79% vs. 71.4%, p =0.001) and fever (18.1% vs. 39.5% vs. 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 five-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 ARS group, even though they expressed milder pulmonary manifestation.

      PubDate: 2017-08-09T12:39:11Z
      DOI: 10.1016/j.amjms.2017.07.013
       
  • Plasma Electrolyte Distributions in Humans. Normal or Skewed'
    • Authors: Mark Feldman; Beverly Dickson
      Abstract: Publication date: Available online 27 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Mark Feldman, Beverly Dickson
      Background It is widely believed that plasma electrolyte levels are normally distributed. Statistical tests and calculations using plasma electrolyte data are often reported based on this assumption of normality. Examples include t tests, analysis of variance, correlations, and confidence intervals. The purpose of our study was to determine whether plasma sodium (Na+), potassium (K+), chloride (Cl-), and bicarbonate (HCO3 -) distributions are indeed normally distributed. Methods We analyzed plasma electrolyte data from 237 consecutive adults (137 women and 100 men) who had normal results on a standard basic metabolic panel which included plasma electrolyte measurements. The skewness of each distribution (as a measure of its asymmetry) was compared to the zero skewness of a normal (Gaussian) distribution. Results The plasma Na+ distribution was skewed slightly to the right, but the skew was not significantly different from zero skew. The plasma Cl- distribution was skewed slightly to the left, but again the skew was not significantly different from zero skew. On the other hand, both the plasma K+ and HCO3 - distributions were significantly skewed to the right (p<0.01 zero skew). There was also a suggestion from examining frequency distribution curves that K+ and HCO3 - distributions were bimodal. Conclusions In adults with a normal basic metabolic panel, plasma potassium and bicarbonate levels are not normally distributed and may be bimodal. Thus, statistical methods to evaluate these two plasma electrolytes should be non-parametric tests and not parametric ones that require a normal distribution. (Word count, 239)

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.07.012
       
  • Elevated Serum Midkine in Patients With Acute Pancreatitis
    • Authors: Yao Li; Yongda Lu; Jiaqing Shen; Chunfang Xu
      Abstract: Publication date: Available online 25 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Yao Li, Yongda Lu, Jiaqing Shen, Chunfang Xu
      Background Midkine (MK) is reported to be involved in the pathogenesis of numerous pathologies, but the expression of MK in acute pancreatitis (AP) has not been well studied and documented. Methods In this study, the temporal changes of serum MK were assessed in 97 patients with AP by enzyme-linked immunosorbent assay (ELISA). Results The concentration of serum MK increased along with the severity of AP. Serum MK level increased more significantly in patients with organ failure than those without organ failure. A more obvious elevation of serum MK level was also observed in patients with pancreatic necrosis. Conclusion Serum MK might be a useful marker in the clinical diagnosis of AP.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.07.010
       
  • Socioeconomic, Psychosocial, and Behavioral Characteristics of Patients
           Hospitalized with Cardiovascular Disease
    • Authors: Matthew E. Dupre; Alicia Nelson; Scott M. Lynch; Bradi B. Granger; Hanzhang Xu; Erik Churchill; Janese M. Willis; Lesley H. Curtis; Eric D. Peterson
      Abstract: Publication date: Available online 25 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Matthew E. Dupre, Alicia Nelson, Scott M. Lynch, Bradi B. Granger, Hanzhang Xu, Erik Churchill, Janese M. Willis, Lesley H. Curtis, Eric D. Peterson
      Background Recent studies have drawn attention to non-clinical factors to better understand disparities in the development, treatment, and prognosis of patients with cardiovascular disease. However, there has been limited research describing the non-clinical characteristics of patients hospitalized for cardiovascular care. Methods Data for this study come from 520 patients admitted to the Duke Heart Center from January 1, 2015 through January 10, 2017. Electronic medical records and a standardized survey administered prior to discharge were used to ascertain detailed information on patients′ demographic (age, sex, race, marital status, and living arrangement), socioeconomic (education, employment, and health insurance), psychosocial (health literacy, health self-efficacy, social support, stress, and depressive symptoms), and behavioral (smoking, drinking, and medication adherence) attributes. Results Study participants were a median age of 65 years, predominantly male (61.4%), non-Hispanic white (67.1%), hospitalized for 5.11 days, and comparable to all patients admitted during this period. Results from the survey showed significant heterogeneity among patients in their demographic, socioeconomic, and behavioral characteristics. We also found that the patients′ levels of psychosocial risks and resources were significantly associated with many of these non-clinical characteristics. Patients who were older, women, non-white, and unmarried had generally lower levels of health literacy, self-efficacy, and social support and higher levels of stress and depressive symptoms than their counterparts. Conclusions Patients hospitalized with cardiovascular disease have diverse non-clinical profiles that have important implications for targeting interventions. A better understanding of these characteristics will enhance the personalized delivery of care and improve outcomes in vulnerable patient groups.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.07.011
       
  • Southern Society for Clinical Investigation Founders’ Medal Award
           History
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Southern Society for Clinical Investigation 2017-2018 Officers
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Southern Society for Clinical Investigation 2017–2018 Councilors
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Southern Society for Clinical Investigation: Past Presidents
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Southern Society for Clinical Investigation 2017 Newly Elected Members
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Southern Society for Clinical Investigation 2017-2018 Committee List
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Southern Society for Clinical Investigation 2017 Award Recipients
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • The American Journal of the Medical Sciences Editorial Office
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Southern Society for Clinical Investigation Nephrology Young
           Investigators’ Forum
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Other Societies Represented at the Southern Regional Meeting
    • Abstract: Publication date: July 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 1


      PubDate: 2017-07-31T09:59:24Z
       
  • Current trends on Bacterial etiology of Lower Respiratory Tract Infection
           and their Antimicrobial Susceptibility in Enugu
    • Authors: Maduakor Uzoamaka; Onyemelukwe Ngozi; Ogboi Sonny Johnbull; Ohanu Martin
      Abstract: Publication date: Available online 27 June 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Maduakor Uzoamaka, Onyemelukwe Ngozi, Ogboi Sonny Johnbull, Ohanu Martin
      Background/aim Lower respiratory tract infection (LRTI) is one of the common major health problems in Nigeria, which causes morbidity and mortality. The study was carried out to determine the current trends of bacterial etiology of LRTIs among the patients that attended the University of Nigeria Teaching Hospital (UNTH), and their antimicrobial susceptibility profile with special interest on pandrug resistance (PDR) Methods The study was conducted between February 2014 and June 2016 in the bacteriology laboratory of UNTH. A sputum sample of 954 patients with suspected LRTIs was received, after obtaining patient′s informed consent and ethical clearance from the UNTH. The samples were collected and processed according to standard laboratory procedures. Results The mean age of the patients was 42.6 ± 16.8. Of the total 954 sputum samples, 431 (45.2%) were positive for microorganisms. A single, unique pathogen was recovered in 415 (96.3%) patients each and 16 (3.7%) were polymicrobial. The most predominant single pathogen was Klebsiella pneumonia, 215 (49.9%), and the most prevalent bacterial combination was Klebsiella spp. and Pseudomonas aeruginosa, 6 (1.4%). Antimicrobial susceptibility testing shows that most isolates of Klebsiella pneumoniae were susceptible to Imipenem (94.8%). Among the bacteria, Escherichia coli, (13.3%) ranked highest, followed by Pseudomonas aeruginosa, (12.5%), and the least was Staphylococcus aureus, (2.1%). Conclusion The diversity of pathogens responsible for LRTIs and antibiotic resistance surveillance as well as their susceptibility patterns to antibiotics is important in the effective management of LRTI with prompt clinical and laboratory diagnosis along with appropriate treatment strategies.

      PubDate: 2017-07-31T09:59:24Z
      DOI: 10.1016/j.amjms.2017.06.025
       
  • Anti-phospholipid Antibodies and Heart Valve Disease in Systemic Lupus
           Erythematosus
    • Authors: Daniel Ruiz; Jim C. Oates; Diane L. Kamen
      Abstract: Publication date: Available online 20 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Daniel Ruiz, Jim C. Oates, Diane L. Kamen
      Purpose Evaluation of antiphospholipid antibodies (aPL) and correlation with heart valve abnormalities among SLE patients. Methods Nested case-control study was conducted with 70 SLE patients selected from a longitudinal database based on levels of aPL and presence or absence of valve disease by echocardiogram. Results Valvular abnormalities observed were regurgitation (52), other (14), artificial valves (4), stenosis (2), thickening (2), and no Libman-Sacks endocarditis (0). The mitral valve was the most commonly affected (30 abnormalities), followed by the tricuspid (20 abnormalities). Multivariate logistic regression for those with and without an aPL value ≥ 20 units/mL, adjusted for disease duration and age, showed significant differences for any valve abnormality (OR=3.1, CI 95% 1.0–8.9, p=0.041) and individually for the tricuspid valve (OR=3.3, CI 95% 1.0–11.1, p=0.052) but not for the mitral valve (OR=2.1, CI 95% 0.68–6.45, p=0.195). Levels of aPL ≥ 20 units/mL showed no association with aortic (p=0.253), pulmonic (p=1.000), tricuspid (p=0.127), or mitral (p=0.249) valve abnormalities. Conclusion Levels of aPL correlate with certain valvular abnormalities among SLE patients.

      PubDate: 2017-07-24T05:57:50Z
      DOI: 10.1016/j.amjms.2017.07.007
       
  • Drug Coated Balloon Versus Drug Eluting Stent in Primary Percutaneous
           Coronary Intervention: A Feasibility Study
    • Authors: David Gobić; Vjekoslav Tomulić; Davorka Lulić; David Židan; Sandro Brusich; Tomislav Jakljević; Luka Zaputović
      Abstract: Publication date: Available online 19 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): David Gobić, Vjekoslav Tomulić, Davorka Lulić, David Židan, Sandro Brusich, Tomislav Jakljević, Luka Zaputović
      Background Drug eluting stents (DES) represent a significant evolution in the treatment of patients with acute myocardial infarction with ST elevation (STEMI). However, stent-related adverse events have led to an introduction of drug coated balloons (DCB) applied particularly to bifurcation lesions, in-stent restenosis (ISR) and small vessel disease. The aim of this study was to determine whether DCB-only strategy has a similar safety profile and equal angiographic and clinical outcomes to DES implantation in primary percutaneous coronary intervention (pPCI). Methods Seventy-five STEMI patients were randomized into DES and DCB groups of 37 and 38 patients, respectively. The study end-points were major adverse cardiac events (MACEs) and the late lumen loss (LLL) during the 6 months following the pPCI. Results Reinfarction occurred in 5.4% of patients in the DES and 5.3% of patients in the DCB group after 1 month (RR 1.03, 95% CI [0.15 to 6.91], P=0.98). After 6 months, MACEs were reported in 5.4% patients in the DES group and none in the DCB group (RR 5.13, 95% CI [0.25 to 103.42], P=0.29). LLL in the DES group was 0.10 ± 0.19 mm and -0.09 ± 0.09 mm in the DCB group (P<0.05). Conclusion A DCB-only strategy is safe and feasible in the pPCI setting, and showed good clinical and angiographic outcomes in 6 months follow-up period.

      PubDate: 2017-07-24T05:57:50Z
      DOI: 10.1016/j.amjms.2017.07.005
       
  • Elevated Admission Potassium Levels and 1-Year and 10-Year Mortality Among
           Patients with Heart Failure
    • Authors: Anan Younis; Ilan Goldenberg; Ronen Goldkorn; Arwa Younis; Yael Peled; Boaz Tzur; Robert Klempfner
      Abstract: Publication date: Available online 19 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Anan Younis, Ilan Goldenberg, Ronen Goldkorn, Arwa Younis, Yael Peled, Boaz Tzur, Robert Klempfner
      Background Limited, contradictory data exists regarding the effect of hyperkalemia on both short and long-term all-cause mortality among hospitalized patients with heart failure (HF). Methods We analyzed 4,031 patients who were enrolled in the Heart Failure Survey in Israel. The study patients were grouped into 3 different potassium (K) categories. Multivariate analysis was used to determine the association of potassium levels as well as 1 and 10 year all-cause mortality. Results A total of 3,349 patients (83%) had K<5mEq/L, whereas 461 patients (11%) had serum K≥5mEq/L but≤ 5.5mEq/L, and 221 patients (6%) had K>5.5mEq/L. Survival analysis showed that 1-year mortality rates were significantly higher among patients with K> 5.5mEq/L (40%) and those with serum K≥5mEq/L but ≤ 5.5mEq/L (34%) compared to those with K<5mEq/L (27%);(all log- rank p <0.01). Similarly, 10-year mortality rates among those with K>5.5mEq/L were 92% whereas among those with serum K≥5mEq/L but ≤ 5.5mEq/L rates were 88% and in those with K<5mEq/L rates were 82%; (all log-rank p <0.001). Consistently, multivariate analysis showed that compared to patients with K<5mEq/L, patients with K>5.5mEq/L had an independently 51% and 31% higher mortality risk at 1 year and 10 years, respectively (1 year Hazard ratio 1.51; 95%CI 1.04–2.2; 10 years Hazard ratio 1.31; 95%CI 1.035–1.66), whereas patients with serum K≥5mEq/L but≤ 5.5mEq/L had comparable adjusted mortality risk to patients with K<5mEq/L at 1 and 10 years. Conclusions Among hospitalized patients with HF, admission K >5.5mEq/L was independently associated with increased short and long-term mortality, whereas serum K≥5mEq/L but≤ 5.5mEq/L was not independently associated with worse outcomes.

      PubDate: 2017-07-24T05:57:50Z
      DOI: 10.1016/j.amjms.2017.07.006
       
  • Uremic Leontiasis Ossea
    • Authors: Eric T. Stoopler; Ashwag Aloyouny; Martin S. Greenberg
      Abstract: Publication date: Available online 15 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Eric T. Stoopler, Ashwag Aloyouny, Martin S. Greenberg


      PubDate: 2017-07-24T05:57:50Z
      DOI: 10.1016/j.amjms.2017.07.004
       
  • Combined assessment of relaxin and B-type natriuretic peptide improves
           diagnostic value in Chinese patients with congestive heart failure: a
           pilot study
    • Authors: Ling Han; Jingguang Luo; Shanshan Bai; Ye Jia; Xin Chen; Yan Zhao; Liwei Chen; Xiaogang Zhu; Ying Li; Yuanyuan Jiang; Xiaohong Li; Ming Yang; Dongxia Li; Xu Teng; Yongfen Qi
      Abstract: Publication date: Available online 10 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Ling Han, Jingguang Luo, Shanshan Bai, Ye Jia, Xin Chen, Yan Zhao, Liwei Chen, Xiaogang Zhu, Ying Li, Yuanyuan Jiang, Xiaohong Li, Ming Yang, Dongxia Li, Xu Teng, Yongfen Qi
      Background To improve the poor prognosis of congestive heart failure (CHF), early and accurate diagnosis is necessary. Relaxin is an endogenous cardiovascular peptide, and its plasma levels are usually increased in patients with CHF. In this pilot study, we aimed to determine the diagnostic value of relaxin and B-type natriuretic peptide (BNP) in Chinese patients with and without CHF. Methods The plasma level of relaxin was measured by ELISA and plasma level of BNP by fluorescence immunoassay. The area under the receiver operating characteristic curve was used to assess the diagnostic value of relaxin and BNP. Results We included 81 patients with decompenstated CHF and 36 controls. Plasma levels of relaxin and BNP were both higher in CHF patients than in controls. The correlation between plasma levels of relaxin and BNP and between relaxin or BNP and cardiac function was nonlinear. Relaxin had medium diagnostic value, and BNP had higher value for cardiac function and CHF. At a cutoff of 39.76pg/ml relaxin, sensitivity was 82.7%, specificity 55.6%, sum of the highest positive predictive value 80.5%, and negative predictive value 58.8%. Although the diagnostic value was not better for relaxin than BNP, their combined assessment improved the sensitivity and specificity of diagnosis for CHF as compared with BNP alone. Conclusions Combined assessment of relaxin and BNP may improve the diagnosis of decompensated CHF, which may have potential application in the clinic.

      PubDate: 2017-07-13T22:42:35Z
      DOI: 10.1016/j.amjms.2017.07.002
       
  • Association of Bone Metabolic Markers with Diabetic Retinopathy and
           Diabetic Macular Edema in Elderly Chinese Individuals with Type 2 Diabetes
           Mellitus
    • Authors: Xiao Zhang; Jingyun Yang; Yong Zhong; Lingling Xu; Ou Wang; Ping Huang; Chunying Li; Bin Qu; Jing Wang; Caixia Zheng; Meng Niu; Weihong Yu
      Abstract: Publication date: Available online 10 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Xiao Zhang, Jingyun Yang, Yong Zhong, Lingling Xu, Ou Wang, Ping Huang, Chunying Li, Bin Qu, Jing Wang, Caixia Zheng, Meng Niu, Weihong Yu
      Background Diabetic retinopathy (DR) is a common and specific microvascular complication of diabetes. The association of bone metabolic markers with the risk of DR and diabetic macular edema (DME) is unclear. Materials and Methods We investigated the association between bone turnover markers commonly examined in a clinical setting and DR and DME risk in elderly Chinese patients with type 2 diabetes mellitus (T2DM). A total of 408 patients aged 55 to 70 years old with T2DM were included. We first performed univariable logistic regression followed by multivariable logistic regression that included variables selected using purposeful selection. Results Fasting blood glucose (P=0.007) and duration of diabetes (P<0.0001) were significantly associated with DME in multivariable logistic regression; however, the association of β-CTx with DME risk was not statistically significant (P=0.053). Sex-stratified analysis showed that β-CTx was significantly associated with DME only in female subjects (P=0.011). Conclusions β-CTx had no significant association with DR. It was significantly associated with DME in female T2DM patients but not in male T2DM patients. More prospective studies with larger sample sizes are warranted to validate our findings.

      PubDate: 2017-07-13T22:42:35Z
      DOI: 10.1016/j.amjms.2017.07.003
       
  • Chronic Critical Illness: The Limbo Between Life and Death
    • Authors: Rosechelle M. Ruggiero
      Abstract: Publication date: Available online 10 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Rosechelle M. Ruggiero
      The entity of chronic critical illness (CCI) has shown a rise in the past decades in terms of popularity and prevalence. CCI is loosely defined as the group of patients who require the intensive care setting for weeks to months; its hallmark is prolonged mechanical ventilation. The outcomes of the chronically critically ill have been dismal and have not improved over time; one-year survival hovers at approximately 50%. Given the high mortality, prognostic variables are important when making medical decisions. CCI encompasses a syndrome that includes altered pathophysiology across a variety of organ systems. Another crucial element of CCI is the symptom burden that patients experience which include feelings of dyspnea, difficulty communicating, and pain. This patient population necessitates the combined efforts of multiple care teams and the early integration of palliative and critical care. Future directions need to include improving the symptom management and communication for patients with CCI.

      PubDate: 2017-07-13T22:42:35Z
      DOI: 10.1016/j.amjms.2017.07.001
       
  • Metformin Use and Vitamin B12 deficiency—Untangling the Association
    • Authors: René Rodríguez-Gutiérrez; Juan Montes-Villarreal; Karla Victoria Rodríguez-Velver; Camilo González-Velázquez; Alejandro Salcido-Montenegro; Anasofia Elizondo-Plazas; José Gerardo González-González
      Abstract: Publication date: Available online 8 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): René Rodríguez-Gutiérrez, Juan Montes-Villarreal, Karla Victoria Rodríguez-Velver, Camilo González-Velázquez, Alejandro Salcido-Montenegro, Anasofia Elizondo-Plazas, José Gerardo González-González
      Introduction Current evidence linking vitamin B12 deficiency with metformin use is inconsistent. Hence, there is uncertainty regarding the diagnostic approach in this scenario. Furthermore, this possible association has not been studied in the complete spectrum of patients with diabetes. Methods We conducted a cross-sectional, controlled study with the objective of assessing differences in serum vitamin B12 levels among patients with and without diabetes with different metformin treatment regimens. A total of 150 participants were recruited: patients with diabetes (Group 1. metformin alone ≥ 850mg/day, group 2. patients with type 2 diabetes naive to treatment, and group 3. metformin ≥ 850mg/day, in addition to any other oral glucose lowering agent and/or insulin) and without diabetes (Group 4. polycystic ovary syndrome or group 5. healthy individuals). Serum vitamin B12, folate levels, and complete blood counts were obtained for the entire population. Methylmalonic acid and homocysteine were obtained for patients when vitamin B12 levels were found to be borderline or low. Results When patients with or without diabetes were compared, no significant difference was found in relation to their vitamin B12 levels (517.62 vs 433.83P = 0.072). No difference in vitamin B12 levels was found among participants with metformin use and metformin naïve participants (503.4 vs 462.3P=0.380). Conclusion Irrespective of metformin use, no significant difference in the serum levels of vitamin B12 was observed, both in patients with and without diabetes. In the light of the body of evidence and the results of this study, a universal recommendation for vitamin B12 deficiency screening cannot be made.

      PubDate: 2017-07-13T22:42:35Z
      DOI: 10.1016/j.amjms.2017.04.010
       
  • Spontaneous Pneumomediastinum in Dermatomyositis
    • Authors: Vishnu Mohan; Sujith V. Cherian
      Abstract: Publication date: Available online 4 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Vishnu Mohan, Sujith V. Cherian


      PubDate: 2017-07-04T17:58:50Z
      DOI: 10.1016/j.amjms.2017.06.027
       
  • Functional impairment of thyroid function in critically ill patients in
           the Intensive Care Units☆
    • Authors: Eashaa Kumar; Michael T. McCurdy; Christian A. Koch; Abdurrahman Hamadah; Tibor Fülöp; Kamel A. Gharaibeh
      Abstract: Publication date: Available online 1 July 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Eashaa Kumar, Michael T. McCurdy, Christian A. Koch, Abdurrahman Hamadah, Tibor Fülöp, Kamel A. Gharaibeh
      Unexplained hypotension in the intensive care unit (ICU) is commonly attributed to volume depletion, cardiorespiratory failure, sepsis, or relative adrenal insufficiency. In these acute conditions, thyroid hormone levels measured in blood/serum/plasma are often altered and solely attributed to critical illness. We report a series of three critically ill patients with prolonged respiratory failure, suppressed mental status, and unexplained hypotension. Thyroid stimulating hormone (TSH) levels ranged from normal to mildly elevated (2.36–7.65 IU/mL; normal: 0.27–4.20), but free T4 was markedly suppressed (0.239–0.66 ng/dL; normal: 0.93–1.70). After initiation of intravenous levothyroxine (75–100mcg/day), the patients could be weaned off vasopressors and successfully extubated shortly thereafter. These cases demonstrate that hypothyroid ICU patients may exhibit even seemingly normal or mildly abnormal TSH values. Early recognition and treatment of a hypothyroid state superimposed on critical illness may contribute to recovery from hypotension or the need for mechanical ventilation.

      PubDate: 2017-07-04T17:58:50Z
      DOI: 10.1016/j.amjms.2017.06.026
       
 
 
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