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  Subjects -> MEDICAL SCIENCES (Total: 7268 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (198 journals)
    - ANAESTHESIOLOGY (104 journals)
    - CARDIOVASCULAR DISEASES (306 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (21 journals)
    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (199 journals)
    - DENTISTRY (247 journals)
    - DERMATOLOGY AND VENEREOLOGY (147 journals)
    - EMERGENCY AND INTENSIVE CRITICAL CARE (107 journals)
    - ENDOCRINOLOGY (137 journals)
    - FORENSIC SCIENCES (33 journals)
    - GASTROENTEROLOGY AND HEPATOLOGY (162 journals)
    - GERONTOLOGY AND GERIATRICS (115 journals)
    - HEMATOLOGY (141 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (134 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (87 journals)
    - MEDICAL GENETICS (59 journals)
    - MEDICAL SCIENCES (1810 journals)
    - NURSES AND NURSING (294 journals)
    - OBSTETRICS AND GYNECOLOGY (173 journals)
    - ONCOLOGY (351 journals)
    - OPHTHALMOLOGY AND OPTOMETRY (122 journals)
    - ORTHOPEDICS AND TRAUMATOLOGY (146 journals)
    - OTORHINOLARYNGOLOGY (72 journals)
    - PATHOLOGY (97 journals)
    - PEDIATRICS (241 journals)
    - PHYSICAL MEDICINE AND REHABILITATION (138 journals)
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    - RADIOLOGY AND NUCLEAR MEDICINE (180 journals)
    - RESPIRATORY DISEASES (90 journals)
    - RHEUMATOLOGY (63 journals)
    - SPORTS MEDICINE (68 journals)
    - SURGERY (353 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (135 journals)

MEDICAL SCIENCES (1810 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 4)
ABCS Health Sciences     Open Access   (Followers: 1)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Full-text available via subscription   (Followers: 39)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access   (Followers: 1)
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access  
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access  
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 2)
Addiction Science & Clinical Practice     Open Access   (Followers: 7)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Advanced Health Care Technologies     Open Access   (Followers: 4)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 8)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 5)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29)
Advances in Life Course Research     Hybrid Journal   (Followers: 8)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Medical Education and Practice     Open Access   (Followers: 26)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Medicine     Open Access   (Followers: 2)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4)
Advances in Molecular Oncology     Open Access   (Followers: 1)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Therapy     Hybrid Journal   (Followers: 5)
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)
Advances in Wound Care     Hybrid Journal   (Followers: 10)
African Health Sciences     Open Access   (Followers: 2)
African Journal of Biomedical Research     Open Access  
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 1)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 1)
African Journal of Trauma     Open Access  
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 8)
AJOB Primary Research     Partially Free   (Followers: 3)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access  
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 2)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
American Journal of Biomedical Engineering     Open Access   (Followers: 11)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 6)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 5)
American Journal of Clinical Medicine Research     Open Access   (Followers: 6)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 13)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 11)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 1)
American Journal of Medicine     Hybrid Journal   (Followers: 45)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access  
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 9)
American Medical Journal     Open Access   (Followers: 4)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 4)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 2)
Anatomical Science International     Hybrid Journal   (Followers: 2)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Annales de Pathologie     Full-text available via subscription  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 1)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 3)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 8)
Annals of Family Medicine     Open Access   (Followers: 13)
Annals of Fundeni Hospital     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 11)
Annals of Medicine and Surgery     Open Access   (Followers: 5)
Annals of Microbiology     Hybrid Journal   (Followers: 10)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 4)
Annual Review of Medicine     Full-text available via subscription   (Followers: 18)
Anthropological Review     Open Access   (Followers: 24)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 2)
Applied Medical Informatics     Open Access   (Followers: 11)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arak Medical University Journal     Open Access  
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Biomedical Sciences     Open Access   (Followers: 7)
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Trauma Research     Open Access   (Followers: 2)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access  
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 10)
Arterial Hypertension     Open Access  
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 12)
Artificial Organs     Hybrid Journal   (Followers: 1)
Asia Pacific Family Medicine     Open Access  
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 10)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 1)
Asian Journal of Cell Biology     Open Access   (Followers: 6)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 2)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 1)
Asian Journal of Scientific Research     Open Access   (Followers: 1)
Asian Journal of Transfusion Science     Open Access   (Followers: 2)
Asian Medicine     Hybrid Journal   (Followers: 4)
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Audiology - Communication Research     Open Access   (Followers: 8)
Auris Nasus Larynx     Full-text available via subscription  
Australasian Medical Journal     Open Access   (Followers: 3)
Australian Coeliac     Full-text available via subscription   (Followers: 2)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Aviation, Space, and Environmental Medicine     Full-text available via subscription   (Followers: 9)
Avicenna     Open Access   (Followers: 2)
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 1)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 3)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 2)
Bangladesh Journal of Medical Physics     Open Access  
Bangladesh Journal of Medical Science     Open Access  
Bangladesh Journal of Medicine     Open Access   (Followers: 1)
Bangladesh Journal of Physiology and Pharmacology     Open Access  
Bangladesh Journal of Scientific Research     Open Access   (Followers: 1)
Bangladesh Medical Journal     Open Access  
Bangladesh Medical Journal Khulna     Open Access  
Bangladesh Medical Research Council Bulletin     Open Access  
Basal Ganglia     Hybrid Journal  
Basic Sciences of Medicine     Open Access   (Followers: 2)
BBA Clinical     Open Access  
BC Medical Journal     Free  
Benha Medical Journal     Open Access  
Bijblijven     Hybrid Journal  
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Bio-Algorithms and Med-Systems     Hybrid Journal   (Followers: 1)
Bioelectromagnetics     Hybrid Journal   (Followers: 1)
Bioengineering & Translational Medicine     Open Access  
Bioethics     Hybrid Journal   (Followers: 14)
Bioethics Research Notes     Full-text available via subscription   (Followers: 14)
Biologics in Therapy     Open Access  
Biology of Sex Differences     Open Access   (Followers: 4)
Biomarker Research     Open Access   (Followers: 2)

        1 2 3 4 5 6 7 8 | Last

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]
  • Aggressive Multiple Cystic Changes in Lung Adenocarcinoma: An Unusual
           Presentation
    • Authors: Tingting Wu; Qunli Ding; Yiming Yu; Zaichun Deng
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Tingting Wu, Qunli Ding, Yiming Yu, Zaichun Deng


      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.04.018
       
  • Potassium Is Nearly Everywhere
    • Authors: Harold Smulyan
      Pages: 221 - 222
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Harold Smulyan


      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.08.024
       
  • Islamic Medicine in the Middle Ages
    • Authors: Hawa Edriss; Brittany N. Rosales; Connie Nugent; Christian Conrad; Kenneth Nugent
      Pages: 223 - 229
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Hawa Edriss, Brittany N. Rosales, Connie Nugent, Christian Conrad, Kenneth Nugent
      The Islamic culture flourished between the 9th and 13th centuries. Scholars from this era made significant contributions in mathematics, science and medicine. Caliphs and physicians built hospitals that provided universal care and the foundation for medical education. Physician-scientists made significant advances in medical care, surgery and pharmacology. Notable authorities include al-Razi (865-925 CE) who wrote the Kitab al-Hawi fi al-tibb (The Comprehensive Book on Medicine), a 23-volume textbook that provided the main medical curriculum for European schools into the 14th century. Ibn Sina (980-1037 CE), an extraordinary Persian polymath, wrote al Qanun fi al-Tibb (The Canon of Medicine), an encyclopedic treatment of medicine that combined his own observations with medical information from Galen and philosophy from Aristotle. Mansur (1380-1422 CE) wrote the first color illustrated book on anatomy. Other important physicians compiled information on the use of medication from plants, advanced surgical techniques, including cataract extraction and studied physiology, including the pulmonary circulation. These books and ideas provided the basis for medical care in Europe during its recovery from the Dark Ages.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.03.021
       
  • Indwelling Pleural Catheters for Nonmalignant Effusions: Evidence-Based
           Answers to Clinical Concerns
    • Authors: David Maurice Chambers; Bilal Abaid; Umair Gauhar
      Pages: 230 - 235
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): David Maurice Chambers, Bilal Abaid, Umair Gauhar
      Pleural effusions occur in 1.5 million patients yearly and are a common cause of dyspnea. For nonmalignant effusions, initial treatment is directed at the underlying cause, but when effusions become refractory to medical therapy, palliative options are limited. Tunneled pleural catheters (TPCs) are commonly used for palliation of malignant effusions, but many clinicians are reluctant to recommend these devices for palliation of nonmalignant effusions, citing concerns of infection, renal failure, electrolyte disturbances and protein-loss malnutrition. Based on the published experience to date, TPCs relieve dyspnea and can result in spontaneous pleurodesis in patients with nonmalignant effusions. The infection rate compares favorably to that for malignant effusions with possible increased risk in patients with hepatic hydrothorax and posttransplant patients. Renal failure, electrolyte disturbance and protein-loss malnutrition have not been observed. TPCs are a reasonable option in select patients to palliate nonmalignant effusions refractory to maximal medical therapy.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.03.003
       
  • Crescentic Glomerulonephritis With Immunoglobulin G4–Related Disease
    • Authors: Inbar Raber; Asiri Ediriwickrema; John Higgins; Neeraja Kambham; Alan C. Pao
      Pages: 236 - 239
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Inbar Raber, Asiri Ediriwickrema, John Higgins, Neeraja Kambham, Alan C. Pao
      Immunoglobulin G4 (IgG4)-related disease is an uncommon autoimmune disease that affects multiple organ systems. Renal involvement typically presents as tubulointerstitial nephritis and less commonly as membranous glomerulonephritis. In this case report, we discuss a 68-year-old patient who presented with rapidly progressive glomerulonephritis. His renal biopsy revealed a membranoproliferative pattern of injury with fibrocellular crescents and extensive infiltration of the tubulointerstitium with IgG4-positive plasma cells. We treated the patient with both corticosteroids and rituximab because of the aggressive nature of crescentic glomerulonephritis. The patient demonstrated a partial improvement in kidney function after 2 cycles of rituximab with a decrease in serum creatinine levels from 6.9-4.7mg/dL after 6 months from presentation. This case illustrates the importance of considering IgG4-related disease in cases of rapidly progressive glomerulonephritis and the need for effective treatments for more aggressive forms of this recently recognized disease entity.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2016.09.004
       
  • Awareness of Individual Cardiovascular Risk Factors and Self-Perception of
           Cardiovascular Risk in Women
    • Authors: Jean-Jacques Monsuez; Tai Pham; Nicole Karam; Laurence Amar; Corinne Chicheportiche-Ayache; Philippe Menasché; Michel Desnos; Paul Dardel; Isabelle Weill
      Pages: 240 - 245
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Jean-Jacques Monsuez, Tai Pham, Nicole Karam, Laurence Amar, Corinne Chicheportiche-Ayache, Philippe Menasché, Michel Desnos, Paul Dardel, Isabelle Weill
      Background Cardiovascular risk factors (CVRFs) self-perception by women may be inaccurate. Materials and Methods A questionnaire was completed anonymously Online by women who self-reported their personal CVRF levels including age, weight, contraceptive use, menopausal status, smoking, diet and physical activities. Self-perceived risk was matched to actual cardiovascular risk according to the Framingham score. Results Among 5,240 young and middle-aged women with a high educational level, knowledge of personal CVRFs increased with age, from 51-90% for blood pressure (BP), 22-45% for blood glucose and 15-47% for blood cholesterol levels, between 30 and 65 years, respectively. This knowledge was lower for smoking compared with nonsmoking women: 62.5% vs. 74.5% for BP (P < 0.001), 22.7% vs. 33.8% for blood glucose (P < 0.001), 21.9% vs. 32.0% for cholesterol levels (P < 0.001). Knowledge of BP level was reduced among women using an estrogen-progestogen contraception (56.8% vs. 62.1%, P = 0.0031) and even more reduced among smokers (52.2%, P < 0.001). Conversely, women with leisure-time physical or sportive activity (60.5%), were less overweight or obese (22.4% vs. 34.2%, P < 0.001). They reported better knowledge of BP (72.4% vs. 68.3%, P < 0.001), blood cholesterol (31.1% vs. 26.4%, P < 0.001) and glucose levels (32.7% vs. 27.8%, P < 0.001). Self-perceived cardiovascular risk was rated low by 1,279 (20.4%), moderate by 3,710 (63.3%) and high by 893 (16.3%) women. Among 3,386 women tested using the Framingham score, 40.8% were at low, 25.2% at moderate and 33.8% at high risk. Conclusions Knowledge of CVRFs and self-perception of individual risk are inaccurate in women. Educational interventions should be emphasized.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.05.008
       
  • Metformin Has Positive Therapeutic Effects in Colon Cancer and Lung Cancer
    • Authors: DeAnna Henderson; Danielle Frieson; Jeffrey Zuber; Solomon S. Solomon
      Pages: 246 - 251
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): DeAnna Henderson, Danielle Frieson, Jeffrey Zuber, Solomon S. Solomon
      Background Metformin (MF), a diabetic drug, has antineoplastic activity as adjuvant therapy for breast cancer and prostate cancer. MF is thought to work via inhibition of mammalian target of rapamycin and activation of p53 and liver kinase B1 via adenosine 5′-monophosphate–activated protein kinase. We investigated survival, recurrences and metastasis in patients with type 2 diabetes mellitus (DM2) along with colorectal cancer (CC) or lung cancer (LC) taking MF using the electronic medical record in Memphis Veterans Affairs Medical Center (colon, n = 202; lung, n = 180). Materials and Methods Patients with CC or LC and DM2 on MF were compared to controls taking any medication except MF. Recurrences, metastases, secondary cancers, survival and carcinoembryonic antigen levels were compared using t test and chi-squared test. Inclusion criteria were based on MF use, CC or LC diagnosis and DM2. Results For CC, the MF group noted fewer deaths (48% versus 76%, P < 0.001), recurrences (4% versus 19%, P = 0.002), metastases (23% versus 46%, P = 0.001), better 5-year survival rates (57% versus 37%, P = 0.004), overall survival years (5.7 versus 4.1, P = 0.007) and greater carcinoembryonic antigen decrease (72% versus 47%, P = 0.015). MF was associated with improved 5-year survival rates (29% versus 15%, P = 0.023) and overall survival years (3.4 versus 1.8, P < 0.001) in LC. Conclusions Our study shows that MF therapy is associated with significantly better prognosis in patients with CC and improved survival in LC. Patients with CC on MF had fewer recurrences and metastases. Differences in metabolic pathways between CC and LC likely account for the differences in the effect of MF.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.05.006
       
  • Streptococcus anginosus Group Bacterial Infections
    • Authors: Tasaduq Fazili; Scott Riddell; Deanna Kiska; Tim Endy; Luca Giurgea; Calden Sharngoe; Waleed Javaid
      Pages: 257 - 261
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Tasaduq Fazili, Scott Riddell, Deanna Kiska, Tim Endy, Luca Giurgea, Calden Sharngoe, Waleed Javaid
      Background The Streptococcus anginosus group (SAG) causes a variety of infections in adults. To better understand the burden of SAG infections and their associated morbidity and mortality, we conducted a retrospective analysis of these infections in adults at a tertiary care center. Methods A retrospective review of all cultures positive for SAG in adults and a corresponding review of the patients’ medical records were conducted at a tertiary care facility in central New York. Patients with these cultures during the period of January 2007-December 2011 were included. Demographic data, area of residence, clinical features and underlying illnesses, site of infection, length of hospital stay, antibiotic susceptibility and antibiotic therapy were recorded and analyzed. Results There were 332 SAG cases; most patients were males (59%), mean age of 47 years and 84% lived in urban areas. Overall mortality was 3% with underlying conditions common such as diabetes (25%), hypertension (31%) and immunodeficiency (22%). Most of the infections were related to skin and soft tissue (72%) and polymicrobial (70%) with gram-negative anaerobes and Enterobacteriaceae commonly isolated with SAG. Conclusions We present the largest study, thus far, reviewing the clinical presentation, management and outcome of infections due to the SAG of organisms. Notable findings from our study are the low mortality associated with SAG infection, and the propensity to present as a skin and tissue and polymicrobial infection. Our findings will assist clinicians in managing patients with SAG infections and recognizing that S anginosus may be one of several organisms responsible for infection.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.05.011
       
  • Recurrence of Barcelona Clinic Liver Cancer Stage A Hepatocellular
           Carcinoma After Hepatectomy
    • Authors: Hao Zou; Cheng-zhan Zhu; Chang Wang; Zu-sen Wang; Xiang Ma; Bing Han; Li-qun Wu
      Pages: 262 - 267
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Hao Zou, Cheng-zhan Zhu, Chang Wang, Zu-sen Wang, Xiang Ma, Bing Han, Li-qun Wu
      Background The Barcelona Clinic Liver Cancer (BCLC) staging system is widely used to classify hepatocellular carcinoma (HCC). This study was performed to investigate the prognostic factors for patients with BCLC stage A HCC after R0 hepatectomy. Methods A total of 592 patients with BCLC stage A HCC following R0 hepatectomy from 1997-2012 were enrolled in this study. Kaplan-Meier analysis and Cox regression were used to analyze the risk factors associated with recurrence. Receiver operating characteristic curves were used to establish a new scoring system to evaluate the independent risk factors for recurrence. Furthermore, subgroup analyses were performed to evaluate surgical margins on tumor recurrence between the anatomic and nonanatomic resection group. Results Independent risk factors for BCLC stage A HCC recurrence were preoperative alanine transaminase >40U/L, liver cirrhosis, surgical margin <5mm, nonanatomic resection and maximum tumor diameter >5cm. Based on these 5 risk factors, we established a new scoring system, named “HCC recurrence scoring system.” Patients with a high score (≥3 points, 1 point for each factor) composed the high recurrence risk group. Moreover, the subgroup analyses demonstrated that different surgical margins had no significant effect on tumor recurrence in the anatomic resection group (P = 0.408), while it had a significant effect in the nonanatomic resection group (P = 0.000). Conclusions For patients with BCLC stage A with scores ≥3 points, close postoperative follow-up and positive measures to prevent recurrence are particularly important. Anatomic resection is preferred for patients with BCLC stage A. Adequate surgical margins are necessary for patients with poor liver function.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.05.014
       
  • 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
      Pages: 268 - 277
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Anan Younis, Ilan Goldenberg, Ronen Goldkorn, Arwa Younis, Yael Peled, Boaz Tzur, Robert Klempfner
      Background Limited, contradictory data exist 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: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.07.006
       
  • Left Ventricular False Tendons are Associated With Left Ventricular
           Dilation and Impaired Systolic and Diastolic Function
    • Authors: Michael E. Hall; Joseph A. Halinski; Thomas N. Skelton; William F. Campbell; Michael R. McMullan; Robert C. Long; Myrna N. Alexander; James D. Pollard; John E. Hall; Ervin R. Fox; Michael D. Winniford; Daisuke Kamimura
      Pages: 278 - 284
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Michael E. Hall, Joseph A. Halinski, Thomas N. Skelton, William F. Campbell, Michael R. McMullan, Robert C. Long, Myrna N. Alexander, James D. Pollard, John E. Hall, Ervin R. Fox, Michael D. Winniford, Daisuke Kamimura
      Background Left ventricular false tendons (LVFTs) are chord-like structures that traverse the LV cavity and are generally considered to be benign. However, they have been associated with arrhythmias, LV hypertrophy and LV dilation in some small studies. We hypothesize that LVFTs are associated with LV structural and functional changes assessed by echocardiography. Methods We retrospectively evaluated echocardiographic and clinical parameters of 126 patients identified as having LVFTs within the past 2 years and compared them to 85 age-matched controls without LVFTs. Results There were no significant differences in age (52 ± 18 versus 54 ± 18 years, P = 0.37), sex (55% versus 59% men, P = 0.49), race (36% versus 23% white, P = 0.07), systolic blood pressure (131 ± 22 versus 132 ± 23mmHg, P = 0.76) or body mass index (BMI, 31 ± 8 versus 29 ± 10kg/m2, P = 0.07) between controls and patients with LVFTs, respectively. Patients with LVFTs had more prevalent heart failure (43% versus 21%, P = 0.001). Patients with LVFTs had more LV dilation, were 2.5 times more likely to have moderate-to-severe mitral regurgitation, had more severe diastolic dysfunction and reduced LV systolic function (18% lower) compared with controls (all P < 0.05). After adjustment for covariates, basal and middle LVFT locations were associated with reduced LV systolic function (P < 0.01), and middle LVFTs were associated with LV dilation (P < 0.01). Conclusions Our findings suggest that LVFTs may not be benign variants, and basal and middle LVFTs may have more deleterious effects. Further prospective studies should be performed to determine their pathophysiological significance and whether they play a causal role in LV dysfunction.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.05.015
       
  • Role of Microalbuminuria in Predicting Cardiovascular Mortality in
           Individuals With Subclinical Hypothyroidism
    • Authors: Tushar A. Tuliani; Maithili Shenoy; Kevin Belgrave; Abhishek Deshmukh; Sadip Pant; Anthony Hilliard; Luis Afonso
      Pages: 285 - 290
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Tushar A. Tuliani, Maithili Shenoy, Kevin Belgrave, Abhishek Deshmukh, Sadip Pant, Anthony Hilliard, Luis Afonso
      Purpose Studies suggest that subclinical hypothyroidism (SCH) is related to cardiovascular mortality (CVM). We explored the role of microalbuminuria (MIA) as a predictor of long-term CVM in population with and without SCH with normal kidney function. Materials and Methods We examined the National Health and Nutrition Education Survey - III database (n = 6,812). Individuals younger than 40 years, thyroid-stimulating hormone levels ≥20 and ≤0.35mIU/L, estimated glomerular filtration rate <60mL/minute/1.73m2 and urine albumin-to-creatinine ratio of >250mg/g in men and >355mg/g in women were excluded. SCH was defined as thyroid-stimulating hormone levels between 5 and 19.99mIU/L and serum T4 levels between 5 and 12µg/dL. MIA was defined as urine albumin-to-creatinine ratio of 17-250mg/g in men and 25-355mg/g in women. Patients were categorized into the following 4 groups: (1) no SCH or MIA, (2) MIA, but no SCH, (3) SCH, but no MIA and (4) both SCH and MIA. Results Prevalence of MIA in the subclinical hypothyroid cohort was 21% compared to 16.4% in those without SCH (P = 0.03). SCH was a significant independent predictor of MIA (n = 6,812), after adjusting for traditional risk factors (unadjusted odds ratio = 1.75; 95% CI: 1.24-2.48; P = 0.002 and adjusted odds ratio = 1.83; 95% CI: 1.2-2.79; P = 0.006). MIA was a significant independent predictor of long-term all-cause (adjusted hazard ratio = 1.7, 95% CI: 1.24-2.33) and CVM (adjusted hazard ratio = 1.72, 95% CI: 1.07-2.76) in subclinical hypothyroid individuals. Conclusions In a cohort of subclinical hypothyroid individuals, the presence of MIA predicts increased risk of CVM as compared to nonmicroalbuminurics with SCH. Further randomized trials are needed to assess the benefits of treating microalbuminuric subclinical hypothyroid individuals and impact on CVM.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.04.022
       
  • Inhibition of Midkine Suppresses Prostate Cancer CD133+ Stem Cell Growth
           and Migration
    • Authors: Suat Erdogan; Zeynep B. Doganlar; Oguzhan Doganlar; Kader Turkekul; Riza Serttas
      Pages: 299 - 309
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Suat Erdogan, Zeynep B. Doganlar, Oguzhan Doganlar, Kader Turkekul, Riza Serttas
      Background Midkine (MDK) is a tumor-promoting factor that is often overexpressed in various human carcinomas, and the role of MDK has not yet been fully investigated in prostate cancer stem cells. Materials and Methods Prostate cancer CD133+ stem cells (PCSCs) were isolated from human castration-resistant PC3 cells. PCSCs were treated with different concentrations of MDK inhibitor, iMDK, for 24-72 hours. The IC50 values were determined by the MTT test. Endogenous MDK messenger RNA expression was knocked down by small interfering RNA. Quantitative reverse transcription polymerase chain reaction, Western blot analyses and image-based cytometry were used to investigate apoptosis and cell cycle progression as well as their underlying molecular mechanisms. Cell migration was evaluated by the wound healing test. Results iMDK caused dose- and time-dependent inhibition of PCSC survival. Similar growth inhibition was also obtained by small interfering RNA–mediated knockdown of endogenous MDK expression. iMDK was shown to preferentially induce cell cycle arrest at the S and G2/M phases. Suppressed PCSC growth was also accompanied by increases in p53 and the cell cycle inhibitor p21 genes. Combinatorial treatment of iMDK with docetaxel significantly inhibited cell proliferation versus either of the agents used alone. Inhibition of MDK expression strongly suppressed the migration of PCSCs compared to untreated and docetaxel-treated cells. iMDK and the knockdown of MDK decreased p-Akt and significantly upregulated the expression of PI3K/phosphatase/tensin homolog. Conclusions Our data indicate that MDK plays a crucial role in controlling PCSC proliferation and migration. Therefore, suppression of endogenous expression of MDK would, in combination with traditional chemotherapy drugs, be a potential treatment for PCSCs.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.04.019
       
  • Prostaglandin E2 Induces Prorenin-Dependent Activation of (Pro)renin
           Receptor and Upregulation of Cyclooxygenase-2 in Collecting Duct Cells
    • Authors: Nicolás Salinas-Parra; Cristian Reyes-Martínez; Minolfa C. Prieto; Alexis A. Gonzalez
      Pages: 310 - 318
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Nicolás Salinas-Parra, Cristian Reyes-Martínez, Minolfa C. Prieto, Alexis A. Gonzalez
      Background Prostaglandin E2 (PGE2) regulates renin expression in renal juxtaglomerular cells. PGE2 acts through E-prostanoid (EP) receptors in the renal collecting duct (CD) to regulate sodium and water balance. CD cells express EP1 and EP4, which are linked to protein kinase C (PKC) and PKA downstream pathways, respectively. Previous studies showed that the presence of renin in the CD, and that of PKC and PKA pathways, activate its expression. The (pro)renin receptor (PRR) is also expressed in CD cells, and its activation enhances cyclooxygenase-2 (COX-2) through extracellular signal–regulated kinase (ERK). We hypothesized that PGE2 stimulates prorenin and renin synthesis leading to subsequent activation of PRR and upregulation of COX-2. Methods We used a mouse M-1 CD cell line that expresses EP1, EP3 and EP4 but not EP2. Results PGE2 (10−6 M) treatment increased prorenin and renin protein levels at 4 and 8 hours. No differences were found at 12-hour after PGE2 treatment. Phospho-ERK was significantly augmented after 12 hours. COX-2 expression was decreased after 4 hours of PGE2 treatment, but increased after 12 hours. Interestingly, the full-length form of the PRR was upregulated only at 12 hours. PGE2-mediated phospho-ERK and COX-2 upregulation was suppressed by PRR silencing. Conclusions Our results suggest that PGE2 induces biphasic regulation of COX-2 through renin-dependent PRR activation via EP1 and EP4 receptors. PRR-mediated increases in COX-2 expression may enhance PGE2 synthesis in CD cells serving as a buffer mechanism in conditions of activated renin-angiotensin system.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.05.018
       
  • Neuroprotective Effects of Eexenatide in a Rotenone-Induced Rat Model of
           Parkinson’s Disease
    • Authors: Dürdane Aksoy; Volkan Solmaz; Türker Çavuşoğlu; Ayfer Meral; Utku Ateş; Oytun Erbaş
      Pages: 319 - 324
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Dürdane Aksoy, Volkan Solmaz, Türker Çavuşoğlu, Ayfer Meral, Utku Ateş, Oytun Erbaş
      Backround Several studies suggest an association between Parkinson’s disease (PD) and type 2 diabetes mellitus; these 2 diseases are both known to affect the common molecular pathways. As a synthetic agonist for the glucagon-like peptide 1 receptor, exenatide has been evaluated as a neuroprotective agent in multiple animal models. Rotenone models of PD have great potential for the investigation of PD pathology and motor and nonmotor symptoms, as well as the role of gene-environment interactions in PD causation and pathogenesis. Therefore, in this study, the neurochemical, behavioral and histologic effects of exenatide on a rotenone-induced rat model of PD were examined. Materials and Methods Eighteen adult male rats were randomly divided into the following 3 groups (n = 6): 1 group received stereotaxical infusion of dimethyl sulfoxide (vehicle, group 1) and the others received stereotaxical infusion of rotenone (groups 2 and 3). Apomorphine-induced rotation test was applied to the rats after 10 days. Thereafter, group 2 was administered isotonic saline, whereas group 3 was administered exenatide for 28 days. Results Malondialdehyde and tumor necrosis factor alpha levels increased in the rats with PD induced by rotenone, whereas malondialdehyde and tumor necrosis factor alpha levels markedly decreased in the rats treated with exenatide. The apomorphine-induced rotation test scores of exenatide-treated rats were determined to be lower compared with the untreated group. Additionally, treatment with exenatide significantly reduced the loss of dopaminergic neurons in striatum. Conclusions These results have shown that exenatide has neuroprotective, anti-inflammatory and antioxidant effects in a rotenone-induced rat model of PD.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.05.002
       
  • Epidural Abscess in Lemierre׳s Syndrome
    • Authors: Christina M. Meade; Valeria D. Cantos; Hachem Nasri; Mara Serbanescu; Evan J. Anderson
      Pages: 325 - 326
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Christina M. Meade, Valeria D. Cantos, Hachem Nasri, Mara Serbanescu, Evan J. Anderson


      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2016.11.017
       
  • Anorectal Malignant Melanoma Presenting as Acute Pancreatitis
    • Authors: Feras Zaiem; Abdulah Alrifai
      Pages: 327 - 328
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Feras Zaiem, Abdulah Alrifai


      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.03.006
       
  • Necrobiotic Pulmonary Nodules of Rheumatoid Arthritis
    • Authors: Satoru Yanagisawa; Chihiro Inoue; Masakazu Ichinose
      First page: 329
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Satoru Yanagisawa, Chihiro Inoue, Masakazu Ichinose


      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.02.007
       
  • Purtscher-like Retinopathy
    • Authors: Ling-ling Liang; Dan-dan Zhou; Cheng-wei Lu
      First page: 330
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): Ling-ling Liang, Dan-dan Zhou, Cheng-wei Lu


      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.02.009
       
  • Caregivers for the Elderly: Caveat Emptor
    • Authors: John Riefler
      Pages: 331 - 332
      Abstract: Publication date: September 2017
      Source:The American Journal of the Medical Sciences, Volume 354, Issue 3
      Author(s): John Riefler


      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2016.06.005
       
  • Cardiogenic Dysphagia: Dysphagia Megalatriensis
    • Authors: Vishal Khurana; Shailesh K. Thakur
      Abstract: Publication date: Available online 12 October 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Vishal Khurana, Shailesh K. Thakur


      PubDate: 2017-10-14T17:03:58Z
      DOI: 10.1016/j.amjms.2017.10.002
       
  • Health Care is a Human Right – Pro
    • Authors: Ann Schraufnagel; William Schraufnagel Dean Schraufnagel
      Abstract: Publication date: Available online 6 October 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Ann M. Schraufnagel, William E. Schraufnagel, Dean E. Schraufnagel


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


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


      PubDate: 2017-10-08T13:46:46Z
       
  • Longitudinal Changes in Insulin Resistance, Beta-Cell Function, and
           Glucose Regulation Status in Koreans with Prediabetes
    • Authors: Chul-Hee Kim; Hong-Kyu Kim; Eun-Hee Kim; Sung-Jin Bae; Jaewon Choe; Joong-Yeol Park
      Abstract: Publication date: Available online 28 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Chul-Hee Kim, Hong-Kyu Kim, Eun-Hee Kim, Sung-Jin Bae, Jaewon Choe, Joong-Yeol Park
      Background The changes in insulin resistance and insulin secretion and their association with changes in glucose regulation status in Asians with prediabetes remain uncertain. Methods We included Korean adults (aged 20–79 years) with prediabetes who underwent routine medical check-ups at a mean interval of 5 years. Prediabetes was defined as fasting plasma glucose 5.6–6.9mmol/l or HbA1c 5.7–6.4% (39–46mmol/mol). Insulin resistance (HOMA-IR) and beta-cell function (HOMA-%B) indices were assessed by homeostasis model assessment. Incident diabetes was defined as FPG≥7.0mmol/l, HbA1c≥6.5% (48mmol/mol), or initiation of antidiabetic medications. Results Among the 7,208 participants with prediabetes, 4,410 (61.2%) remained as prediabetes (control group), 2,123 (29.5%) reverted to normal glucose regulation (regressors), and 675 (9.4%) progressed to type 2 diabetes (progressors) after 5 years. Compared with the control group, the progressors had higher baseline HOMA-IR (2.48±1.45 vs. 2.06±1.20, P<0.001), but similar baseline HOMA-%B (74.6±47.6 vs. 73.1±41.4, P=0.68). By contrast, the regressors had lower baseline HOMA-IR (1.98±1.14 vs. 2.06±1.20, P=0.035) but higher baseline HOMA-%B (77.4±43.1 vs. 73.1±41.4, P=0.001). After 5 years, the progressors showed a 31% increase in HOMA-IR (2.48±1.45 vs. 3.24±2.10, P<0.001) and 15% decrease in HOMA-%B (74.6±47.6 vs. 63.8±40.4, P<0.001), whereas the regressors showed 29% decrease in HOMA-IR (1.98±1.14 vs. 1.41±0.78, P<0.001) and 4% increase in HOMA-%B (77.4±43.1 vs. 80.2±47.9, P=0.010). Conclusions Although increase in insulin resistance and decrease in beta-cell function both contributed to the progression to type 2 diabetes from prediabetes, longitudinal change in insulin resistance was the predominant factor in Koreans.

      PubDate: 2017-09-30T10:03:42Z
      DOI: 10.1016/j.amjms.2017.09.010
       
  • 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
      Abstract: Publication date: Available online 28 September 2017
      Source:The American Journal of the Medical Sciences
      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. Gestational diabetes mellitus 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 ROC curves (AUC) were 0.65 (95% confidence interval (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 cutoff level for identifying subjects with GDM (sensitivity 68.04%, 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: 2017-09-30T10:03:42Z
      DOI: 10.1016/j.amjms.2017.09.012
       
  • 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
      Abstract: Publication date: Available online 21 September 2017
      Source:The American Journal of the Medical Sciences
      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/ reasoning are given. Through analysis of feedback from a post intervention 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 towards historically underserved individuals.

      PubDate: 2017-09-24T07:45:44Z
      DOI: 10.1016/j.amjms.2017.08.021
       
  • Use of liquid biopsy in monitoring colorectal cancer progression shows
           strong clinical correlation
    • Authors: Qiushi Sun; Yuan Liu; Bo Liu; Yingying Liu
      Abstract: Publication date: Available online 20 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Qiushi Sun, Yuan Liu, Bo Liu, Yingying Liu
      Background Colorectal cancer (CRC) patients that are sensitive to epidermal growth factor antibodies inevitably acquire drug resistance. This study aims to determine the usefulness of liquid biopsies for prognosis and clinical correlation. Methods For liquid biopsy tests, we extracted blood from 140 CRC patients with matched tumor samples. Circulating tumor cells (CTCs) and tumor DNA (ctDNA) were extracted before surgery and treatment. Samples were quantified and tested for mutations in KRAS, NRAS and BRAF. Kaplan-Meier analyses were performed for different groups of patients for association to overall survival. Results Among the 140 CRC cases, we observed good agreement collectively in the molecular signatures of CTCs and ctDNA with matched tumor specimens (97% concordance). Patients who were subsequently refractory to either cetuximab or panitumumab showed changes in the molecular profiles and were positive for KRAS, NRAS or BRAF. Interestingly we observed that most of these changes were detected in CTCs analyses first. Stratified analyses conducted by the change in molecular profiles showed this group of patients had worse survival outcome compared with the wild type group. Conclusions Monitoring CRC patients′ molecular changes in response to treatment via CTCs and ctDNA can provide real time information to disease changes. The study demonstrated that the emergence of secondary mutations were strongly associated to poorer survival after treatment.

      PubDate: 2017-09-24T07:45:44Z
      DOI: 10.1016/j.amjms.2017.09.009
       
  • Denosumab-Associated Severe Hypocalcemia in a Patient with Chronic Kidney
           Disease: Case Report and Review of Literature
    • Authors: Sohail Abdul Salim; Lakshmi Ramachandran Nair; Litty Thomas; Vishnu Garla; Venkataraman Palabindala; Mohit Agarwal; Tibor Fülöp
      Abstract: Publication date: Available online 20 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Sohail Abdul Salim, Lakshmi Ramachandran Nair, Litty Thomas, Vishnu Garla, Venkataraman Palabindala, Mohit Agarwal, Tibor Fülöp
      Denosumab is a monoclonal antibody directed against the receptor activator of nuclear factor kappa B ligand (RANKL). Denosumab has been shown to reduce the risk of skeletal-related events, including spinal cord compression, pathologic fracture and hypercalcemia of malignancy in patients with bone metastases. Hypocalcemia is a known side effect of denosumab, occurring in an estimated 8–14% of the patients. Here we present an asymptomatic patient with stage-5 chronic kidney disease and severe hypocalcemia who had received denosumab one month earlier.

      PubDate: 2017-09-24T07:45:44Z
      DOI: 10.1016/j.amjms.2017.09.008
       
  • Trichuriasis☆☆
    • Authors: Raghav Bansal; Tiangui Huang Soohwan Chun
      Abstract: Publication date: Available online 20 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Raghav Bansal, Tiangui Huang, Soohwan Chun


      PubDate: 2017-09-24T07:45:44Z
       
  • 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
      Abstract: Publication date: Available online 20 September 2017
      Source:The American Journal of the Medical Sciences
      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 (DC) is hypothesized to be responsible for these recurrences and the role of adenosine in identification and ablation of these pathways in controversial with conflicting results on AF recurrence. 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/adenosine triphosphate (ATP) and reported freedom from AF patients in patients beyond a minimum follow-up of 6 months in patients. 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. Conclusion Adenosine guided identification and ablation of dormant pathways may lead to a decrease in recurrence of AF.

      PubDate: 2017-09-24T07:45:44Z
      DOI: 10.1016/j.amjms.2017.09.005
       
  • 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
      Abstract: Publication date: Available online 20 September 2017
      Source:The American Journal of the Medical Sciences
      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 ICU patients. Materials and methods Medical ICU 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 percent 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 ROC of 0.75 (95% CI of 0.54–0.96). Conclusions CFTC performs well compared to stroke volume measurements on a Vigileo monitor. The utility of CFTC is highlighted in resource-limited environments and when time limits the use of other methods. Carotid flow time should be validated in a larger study with more operators against a variety of hemodynamic monitors.

      PubDate: 2017-09-24T07:45:44Z
      DOI: 10.1016/j.amjms.2017.09.006
       
  • 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
      Abstract: Publication date: Available online 15 September 2017
      Source:The American Journal of the Medical Sciences
      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, which has been 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 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′s 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 (21.23 per 1000 person-years) developed dementia when compared to 4,419 from 124,836 (18.94 per 1000 person-years) of the controls. Fine and Gray′s competing risk analysis revealed that the study subjects were more likely to develop dementia (hazard ratio [HR]: 2.29, 95% CI =2.16–2.42, p < .001). After adjusting for gender, age, monthly income, urbanization level, geographic region of residence, and comorbidities, the HR was 2.77 (95% CI: 2.61–2.95, p < .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 than the control group. Therefore, further studies are needed to elucidate the underlying mechanisms of the association between fibromyalgia and the risk of dementia.

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.09.002
       
  • Fatal Hypermagnesemia Due to Laxative Use: Case Report and Review of the
           Literature
    • Authors: Syed Rizwan Bokhari; Ravi Siriki; Federico J. Teran; Vecihi Batuman
      Abstract: Publication date: Available online 12 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Syed Rizwan Bokhari, Ravi Siriki, Federico J. Teran, Vecihi Batuman
      We report a case of fatal hypermagnesemia in a 53-year-old woman admitted for acute exacerbation of chronic obstructive pulmonary disease and with a history of chronic constipation treated regularly with magnesium-containing laxatives. On admission, her magnesium level was 2.0mg/dL, which rose to a peak of 10.8mg/dL despite hydration and diuresis in the presence of a normal kidney function. Continuous renal replacement therapy was promptly initiated, which reduced her serum magnesium levels, but her condition continued to deteriorate precipitously progressing to shock leading to oligoanuric renal failure, and she died 2 days later. A review of the literature shows that though rare and often unsuspected, severe hypermagnesemia frequently results in death even in individuals with normal renal function despite renal replacement therapy. In patients with constipation, retention of magnesium-based laxative in the gut apparently serves as a reservoir for continuous magnesium absorption and contributes to mortality

      PubDate: 2017-09-18T05:36:53Z
      DOI: 10.1016/j.amjms.2017.08.013
       
  • Editorial: The distribution of plasma electrolytes
    • Authors: Shruti Gupta; Andrew Z. Fenves
      Abstract: Publication date: Available online 5 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Shruti Gupta, Andrew Z. Fenves


      PubDate: 2017-09-06T01:10:35Z
      DOI: 10.1016/j.amjms.2017.08.025
       
  • The role of a Novel Long Non-Coding RNA TUC40- in Cardiomyocyte Induction
           and Maturation in P19 Cells
    • Authors: Huijuan Li; Li Jiang; Zhangbin Yu; Shuping Han; Xuehua Liu; Mengmeng Li; Chun Zhu; Lixing Qiao; Li Huang
      Abstract: Publication date: Available online 1 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Huijuan Li, Li Jiang, Zhangbin Yu, Shuping Han, Xuehua Liu, Mengmeng Li, Chun Zhu, Lixing Qiao, Li Huang
      Background In previous studies, a new lncRNA TUC40- was found to be overexpressed in human ventricular septal defect (VSD) embryonic heart samples. In this article, we carried out experiments on P19 cell line, in order to elucidate the effects of TUC40- overexpression on cardiomyocyte development relevant to VSD pathogenesis. Methods We established the overexpression cell model by plasmid transfection, and explored the expression profile of Pbx1, the sense gene of TUC40-, and the marker genes of cardiomyocyte linage commitment (Nkx2.5, GATA4) and maturation (CTnT). In addition, we combined cell cycle and CCK8 analysis to detect cell proliferation; used flow cytometry and caspase-3 assays to test apoptosis. At last, bioinformatics analysis was performed to show the possible role of TUC40-. Results In the control group, Pbx1 elevated steadily during cardiomyocyte induction; while in the overexpression group, it showed significantly lower expression at day 6, 8, and 10 of induction. Cells in the overexpression group failed to induce cardiomyocytes indicated by GATA4 and CTnT. Proliferation was inhibited possibly due to G2/M cell cycle arrest and the induced apoptosis rate was higher in the overexpression group. Conclusions TUC40- overexpression reduced Pbx1 expression, cardiomyocyte induction and differentiation, inhibited proliferation and promoted apoptosis. Combining the results and previous studies, we propose TUC40- as a potential pathological factor for VSD.

      PubDate: 2017-09-06T01:10:35Z
      DOI: 10.1016/j.amjms.2017.08.019
       
  • Ghrelin ameliorates asthma by inhibiting endoplasmic reticulum stress
    • Authors: Tian Fu; Lei Wang; Qingdi Zeng; Yan Zhang; Baowei Sheng; Liping Han
      Abstract: Publication date: Available online 1 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Tian Fu, Lei Wang, Qingdi Zeng, Yan Zhang, Baowei Sheng, Liping Han
      Background This study aimed to confirm the ameliorative effect of ghrelin on asthma and investigate its mechanism. Methods The murine model of asthma was induced by ovalbumin (OVA) treatment and assessed by histological pathology and airway responsiveness to methacholine. The total and differential leukocytes were counted. Tumor necrosis factor α (TNFα), interferon γ (IFNγ), interleukin-5 (IL-5) and IL-13 levels in bronchoalveolar lavage fluid were quantified by commercial kits. The protein levels in pulmonary tissues were measured by western blot analysis. Results Ghrelin ameliorated the histological pathology and airway hyperresponsiveness in the OVA-induced asthmatic mouse model. Consistently, OVA-increased total and differential leukocytes, and levels of TNFα, IFNγ, IL-5 and IL-13 in bronchoalveolar lavage fluid were significantly attenuated by ghrelin. Ghrelin prevented the increased protein levels of the endoplasmic reticulum stress markers glucose regulated protein 78 and C/EBP homologous protein and reversed the reduced levels of p-Akt in asthmatic mice. Conclusions Ghrelin might prevent endoplasmic reticulum stress activation by stimulating the Akt signaling pathway, which attenuated inflammation and ameliorated asthma in mice. Ghrelin might be a new target for asthma therapy.

      PubDate: 2017-09-06T01:10:35Z
      DOI: 10.1016/j.amjms.2017.08.022
       
  • Vascular and Splenic Abnormalities in Heterotaxy Syndrome
    • Authors: Kirtipal Bhatia; Abhishek Maiti; Saurav Chatterjee
      Abstract: Publication date: Available online 1 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Kirtipal Bhatia, Abhishek Maiti, Saurav Chatterjee


      PubDate: 2017-09-06T01:10:35Z
      DOI: 10.1016/j.amjms.2017.08.023
       
  • R-wave peak time at lead II in Chinese 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
      Abstract: Publication date: Available online 1 September 2017
      Source:The American Journal of the Medical Sciences
      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 ≥ 50 ms for ventricular tachycardia diagnosis. Our previous study showed that the duration of RWPT at lead II in Chinese adults is ≈29 ms. However, the effects of ventricular premature beats, bundle branch block or left anterior fascicular block 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 ventricular premature beats, bundle branch block or left anterior fascicular block were included. RWPT at lead II was determined. Results Compared with the control groups, the right bundle branch block, left anterior fascicular block, RWPT were longer in groups with left bundle branch block and ventricular premature beats. Compared with the group with left bundle branch block, the group with ventricular premature beats had a significantly longer RWPT at lead II (54.20 ± 18.52 vs 84.76 ± 16.38 ms, P < 0.01). Conclusion Our study showed that there is a significant difference in the RWPT at lead II between groups with left bundle branch block, ventricular premature beat, right bundle branch block and left anterior fascicular block. A RWPT of 50 ms may be optimal to differentiate between VT and SVT with right left bundle branch block and left anterior fascicular block but not with left bundle branch block.

      PubDate: 2017-09-06T01:10:35Z
      DOI: 10.1016/j.amjms.2017.08.017
       
  • Our Evolving Understanding of the Relationship Between Diabetes and Bone
    • Authors: Anupam Kotwal; Matthew T. Drake
      Abstract: Publication date: Available online 1 September 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Anupam Kotwal, Matthew T. Drake


      PubDate: 2017-09-06T01:10:35Z
      DOI: 10.1016/j.amjms.2017.08.016
       
  • Utility of Serum IgG4 Levels in a Multi-Ethnic Population
    • Authors: Ruyu Qi; Luke Y.C. Chen; Sujin Park; Robert Irvine; Michael Seidman; John T. Kelsall; David Collins; Vivian Yin; Graham W. Slack; Andre Mattman; Eric Lam; Mollie N. Carruthers
      Abstract: Publication date: Available online 24 August 2017
      Source:The American Journal of the Medical Sciences
      Author(s): Ruyu Qi, Luke Y.C. Chen, Sujin Park, Robert Irvine, Michael Seidman, John T. Kelsall, David Collins, Vivian Yin, Graham W. Slack, Andre Mattman, Eric Lam, Mollie N. Carruthers
      Background IgG4-related disease (IgG4-RD) is a recently recognized condition defined by characteristic histopathologic findings in affected organs. Serum IgG4 concentration is often but not always elevated. The sensitivity and specificity of serum IgG4 vary greatly across studies and has been anecdotally associated to ethnicity. Our study was conducted to investigate the difference in serum IgG4 levels between Asian and non-Asian patients with IgG4-RD. Methods This is a single-center retrospective study of 26 Asian and 10 non-Asian patients with histologically confirmed IgG4-RD. Serum IgG4 levels, clinical features and other laboratory findings were compared between the two groups. 31 Asian and 11 non-Asian patients with non-IgG4-RD rheumatic diseases were randomly identified to evaluate test characteristics of serum IgG4 measurement. Results Median serum IgG4 at time of diagnosis was significantly higher in Asian (median =11.2g/L, Interquartile range (IQR) =4.6–19.7) than non-Asian patients (median=2.9g/L, IQR= 0.7–5.4, P = 0.0094), as well as the median serum IgG and total protein. Asian patients had more eosinophilia and polyclonal hypergammaglobulinemia than non-Asian patients (P = 0.016 and 0.001 respectively). Test sensitivity was higher in Asian (96%) than non-Asian patients (67%) whereas test specificity was higher in non-Asian patients (91% vs 71%). Conclusion Asian patients with IgG4-RD have more exuberant serum IgG4, IgG and polyclonal hypergammaglobulinemia than non-Asian patients; the mechanism of this difference requires further study. These findings have significant clinical importance and must be accounted for in the diagnostic workup of patients in multi-ethnic settings.

      PubDate: 2017-08-30T20:45:27Z
      DOI: 10.1016/j.amjms.2017.08.014
       
 
 
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