for Journals by Title or ISSN
for Articles by Keywords
help
  Subjects -> MEDICAL SCIENCES (Total: 7797 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (196 journals)
    - ANAESTHESIOLOGY (111 journals)
    - CARDIOVASCULAR DISEASES (323 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (21 journals)
    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (210 journals)
    - DENTISTRY (262 journals)
    - DERMATOLOGY AND VENEREOLOGY (157 journals)
    - EMERGENCY AND INTENSIVE CRITICAL CARE (116 journals)
    - ENDOCRINOLOGY (146 journals)
    - FORENSIC SCIENCES (38 journals)
    - GASTROENTEROLOGY AND HEPATOLOGY (173 journals)
    - GERONTOLOGY AND GERIATRICS (128 journals)
    - HEMATOLOGY (145 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (151 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (94 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (2005 journals)
    - NURSES AND NURSING (316 journals)
    - OBSTETRICS AND GYNECOLOGY (195 journals)
    - ONCOLOGY (359 journals)
    - OPHTHALMOLOGY AND OPTOMETRY (127 journals)
    - ORTHOPEDICS AND TRAUMATOLOGY (159 journals)
    - OTORHINOLARYNGOLOGY (81 journals)
    - PATHOLOGY (100 journals)
    - PEDIATRICS (257 journals)
    - PHYSICAL MEDICINE AND REHABILITATION (149 journals)
    - PSYCHIATRY AND NEUROLOGY (780 journals)
    - RADIOLOGY AND NUCLEAR MEDICINE (187 journals)
    - RESPIRATORY DISEASES (96 journals)
    - RHEUMATOLOGY (66 journals)
    - SPORTS MEDICINE (74 journals)
    - SURGERY (371 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (142 journals)

MEDICAL SCIENCES (2005 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
3D Printing in Medicine     Open Access   (Followers: 1)
AADE in Practice     Hybrid Journal   (Followers: 5)
ABCS Health Sciences     Open Access   (Followers: 3)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 41)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica (Hradec Králové)     Open Access  
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 International     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   (Followers: 1)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 4)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 7)
Addictive Behaviors Reports     Open Access   (Followers: 8)
Adıyaman Üniversitesi Sağlık Bilimleri Dergisi / Health Sciences Journal of Adıyaman University     Open Access  
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access  
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 4)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 7)
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: 1)
Advances in Medical Education and Practice     Open Access   (Followers: 26)
Advances in Medical Ethics     Open Access  
Advances in Medical Research     Open Access  
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: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access  
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 Regenerative Medicine     Open Access   (Followers: 2)
Advances in Skeletal Muscle Function Assessment     Open Access  
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)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 11)
African Health Sciences     Open Access   (Followers: 3)
African Journal of Biomedical Research     Open Access   (Followers: 1)
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 2)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 2)
African Journal of Trauma     Open Access   (Followers: 1)
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)
AJSP: Reviews & Reports     Hybrid Journal  
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
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: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 7)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 11)
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: 4)
American Journal of Medicine     Hybrid Journal   (Followers: 46)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access   (Followers: 1)
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 news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 5)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 5)
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: 5)
Anatolian Clinic the Journal of Medical Sciences     Open Access  
Anatomica Medical Journal     Open Access  
Anatomical Science International     Hybrid Journal   (Followers: 3)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy     Open Access   (Followers: 1)
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
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: 4)
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: 11)
Annals of Family Medicine     Open Access   (Followers: 14)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 11)
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: 16)
Anthropological Review     Open Access   (Followers: 23)
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 Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 10)
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   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
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 Medicine and Surgery     Open Access  
Archives of Trauma Research     Open Access   (Followers: 3)
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 : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 13)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 13)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access  
Asia Pacific Family Medicine     Open Access   (Followers: 1)
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: 3)
Asian Biomedicine     Open Access   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 5)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 4)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 2)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche     Open Access  
Audiology - Communication Research     Open Access   (Followers: 9)
Auris Nasus Larynx     Full-text available via subscription  
Australian Coeliac     Full-text available via subscription   (Followers: 1)
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  
Avicenna     Open Access   (Followers: 3)
Avicenna Journal of Clinical Medicine     Open Access  
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: 3)
Bangladesh Journal of Medical Physics     Open Access  
Bangladesh Journal of Medical Science     Open Access  

        1 2 3 4 5 6 7 8 | Last

Journal Cover
American Journal of the Medical Sciences
Journal Prestige (SJR): 0.767
Citation Impact (citeScore): 1
Number of Followers: 12  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9629
Published by Elsevier Homepage  [3162 journals]
  • Acute lung injury: Endothelial progenitor cells to the rescue'
    • Abstract: Publication date: Available online 11 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Viranuj Sueblinvong, Daniel J. Weiss
       
  • Pancreatic stellate cells activation and matrix metallopeptidase 2
           expression correlate with lymph node metastasis in pancreas carcinoma
    • Abstract: Publication date: Available online 9 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Yueguang Li, Tao Song, Zhen Chen, Yao Wang, Juyuan Zhang, Ximo Wang BackgroundThis study aimed to investigate the correlation between pancreatic stellate cells activation, matrix metallopeptidase 2 (MMP2) expression and lymph node metastasis in pancreas carcinoma.MethodsAlpha-smooth muscle actin (ACTA2), Desmin (DES) and MMP2 were detected in 40 pancreas carcinoma patients and 10 cases normal pancreas tissues using immunohistochemistry. Then MMP2 and ACTA2 expressions profiles in pancreatic cancer were obtained from UCSC (University of California, Santa Cruz) and SurvExpress.ResultsA total of 67.5% and 55.0% of cases positively expressed ACTA2 and DES in pancreas carcinoma, respectively. MMP2 in pancreas carcinoma was expressed in 55.0% of cases, and there were significant differences between the lymph node metastasis group and the lymph node non-metastasis group, as well as the invasion to peripheral tissue group and the non-invasion to peripheral group (P < 0.01). High throughput sequencing databases verified that ACTA2 and MMP2 gene expression were both up-regulated in pancreatic carcinoma tissues.ConclusionsThe co-expression of ACTA2 and DES was related to the expression of MMP2, and positively correlated with lymph node metastasis. Activation of PSC may promote the expression of MMP2 and enhance the invasion and metastasis of pancreas carcinoma.
       
  • Reversible Blindness as Presenting Manifestation of Severe Diabetic
           Ketoacidosis
    • Abstract: Publication date: Available online 4 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Lee B. Bockus, Zain Ul Abideen Asad, Amna Mohyud Din Chaudhary, Ahmed Awab The presenting symptoms of diabetic ketoacidosis (DKA) include abdominal pain, polyuria and nausea. Diabetes has well known chronic ocular complications like glaucoma, cataracts and retinopathy. We report a case of reversible blindness as a presenting manifestation of DKA that has been reported in literature only three times previously. Our objective is to highlight a rare manifestation of a common disease.A 59-year-old-male presented with painless vision loss for three days and was found to have DKA. The blindness was completely reversed with insulin and bicarbonate treatment. The dramatic presentation and reversibility of blindness was found to be intimately tied with the pH of patient's serum. Our report gives mechanistic insight for this interesting condition.Clinicians should be aware of reversible blindness as a complication of DKA. Timely correction of the severe acidosis and other metabolic disturbances of DKA may be instrumental in preventing permanent vision loss.
       
  • Disseminated tuberculosis in the differential diagnosis of hemophagocytic
           syndrome
    • Abstract: Publication date: Available online 3 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Mohammed Ruzieh, Fadi Safi, Joan Duggan
       
  • Staphylococcus aureus and polymicrobial skin and soft tissue
           infections
    • Abstract: Publication date: Available online 2 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Natalia Malachowa, Frank R. DeLeo
       
  • Primary bone marrow diffuse large B-cell lymphoma presenting as transverse
           myelitis
    • Abstract: Publication date: Available online 2 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Lauren Shea, Yan Zhao, Vishnu Reddy, Talene Yacoubian, Amitkumar Mehta Primary bone marrow diffuse large B-cell lymphoma (BM-DLBCL) is uncommon, with prior reports largely limited to small case series. Here, we report the case of a patient who presented with neurologic deficits consistent with acute transverse myelitis and was found to have DLBCL isolated to the bone marrow. We follow this case with a review of the literature summarizing 107 reported cases of BM-DLBCL. Consistent with our case, literature review indicates that BM-DLBCL is characterized by 1) frequent presentation with cytopenias and B symptoms 2) predominant non-germinal center phenotype and 3) aggressive disease with high International Prognostic Index (IPI) score and low overall survival, with a median survival of 10.0 months in our cohort.
       
  • Glycemic Variability: How to Measure and its Clinical Implication for Type
           2 Diabetes
    • Abstract: Publication date: Available online 2 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Guillermo Umpierrez, Boris P. Kovatchev Glycated hemoglobin A1c (A1C) levels have traditionally been the gold standard for assessing glycemic control and treatment efficacy in patients with type 2 diabetes. However, A1C does not take into account fluctuations in blood glucose levels known as glycemic variability (GV). In recent years, GV has become increasingly clinically relevant because of a better understanding of the need to reach target A1C while avoiding hypoglycemia. GV relates to both hyper- and hypoglycemia, and has been associated with poorer quality of life. Diabetes treatments targeting multiple pathophysiological mechanisms are most beneficial in controlling A1C and reducing GV. In clinical trials, a number of metrics are used to measure GV, many of which are not well understood in the clinical practice. Until a gold standard metric for GV is established, the variety of measurements available may confound the choice of an optimal treatment for an individual patient.
       
  • A Missed Connection: Dietary Protein Intake and Mortality in Hemodialysis
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): J. Kevin Tucker
       
  • Congenital Absence of Left Coronary Artery Accompanied by Premature
           Ventricular Complexes
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): Hong-Feng Jin, Xiao-Wei Liu, Chang-Qing Du
       
  • A Rarely Recognized Cause of Acute Kidney Injury in Rhabdomyolysis
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): José Antonio Tesser Poloni, Mark A. Perazella
       
  • Acute Right Ventricular Heart Failure: An Uncommon Case of Thyrotoxicosis
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): Mariella Faccia, Angelo Porfidia, Massimo Montalto Right ventricular failure can be secondary to right ventricular ischemia, pulmonary or tricuspid valvular disease, myocardial shunts, cardiomyopathy, acute and chronic pulmonary hypertension, myocarditis and pericardial disease and it generally carries a poor prognosis. Thyrotoxicosis is a clinical state resulting from high thyroid hormone action in tissues generally due to high thyroid hormone levels. The association between severe hyperthyroidism and high-output heart failure is well-known. Less widespread is the concept that hyperthyroid patients, irrespective of coexisting diseases and through mechanisms not fully elucidated, are at higher risk for pulmonary hypertension and right heart failure, both reversible with the achievement of euthyroidism and associated with a good prognosis. We describe the case of a 44-year-old woman with right ventricular failure and moderate pulmonary hypertension in the setting of thyrotoxicosis, which resolved rapidly after antithyroid treatment. The potential mechanisms underlying this condition will also be discussed.
       
  • A Brain Ring-Enhancing Lesion
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): Mary Lindsey, Nancy Harrison, John Bridges, Jonathan Blossom, Shweta Kishore, Vikas Majithia Neuropsychiatric systemic lupus erythematosus (NPSLE) presents a diagnostic challenge as there is no unified pathophysiological process driving its presentation. Case reports are limited in detailing manifestations and outcomes of NPSLE. This case highlights a unique presentation of NPSLE and discusses challenges associated with diagnosis. A 27-year-old man with systemic lupus erythematosus presented with altered mentation. Initial laboratory results and computed tomography of the brain were unremarkable, but magnetic resonance imaging of the brain revealed ring-enhancing lesions reported as NCC. This led to an extensive infectious disease evaluation, but ultimately there was no evidence of infection. The patient was diagnosed with NPSLE; treatment with intravenous glucocorticoids and cyclophosphamide led to dramatic clinical improvement. Repeat brain magnetic resonance imaging showed resolution of the ringed lesions. This case illustrates the importance of thorough evaluation in immunocompromised patients and warns of the risk of anchoring bias that can lead to diagnostic delays.
       
  • Lancisi’s Sign: The Giant Venous Wave
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): Nicolas Johner, Thibault Ronchard, Olivier Boillat, Georgios Giannakopoulos, Florian Rey
       
  • Clopidogrel Partially Counteracts Adenosine-5′-Diphosphate Effects on
           Blood Pressure and Renal Hemodynamics and Excretion in Rats
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): Malwina Monika Roszkowska-Chojecka, Agnieszka Walkowska, Janusz Sadowski, Leszek Dobrowolski BackgroundAdenosine-5′-diphosphate (ADP) can influence intrarenal vascular tone and tubular transport, partly through activation of purine P2Y12 receptors (P2Y12-R), but their actual in vivo role in regulation of renal circulation and excretion remains unclear.MethodsThe effects of intravenous ADP infusions of 2-8 mg/kg/hour were examined in anesthetized Wistar rats that were untreated or chronically pretreated with clopidogrel, 20 mg/kg/24 hours, a selective P2Y12-R antagonist. Renal blood flow (transonic probe) and perfusion of the superficial cortex and medulla (laser-Doppler fluxes) were measured, together with urine osmolality (Uosm), diuresis (V), total solute (UosmV), sodium (UNaV) and potassium (UKV) excretion.ResultsADP induced a gradual, dose-dependent 15% decrease of mean arterial pressure, a sustained increase of renal blood flow and a 25% decrease in renal vascular resistance. Clopidogrel pretreatment attenuated the mean arterial pressure decrease, and did not significantly alter renal blood flow or renal vascular resistance. Renal medullary perfusion was not affected by ADP whereas Uosm decreased from 1,080 ± 125 to 685 ± 75 mosmol/kg H20. There were also substantial significant decreases in UosmV, UNaV and UKV; all these changes were attenuated or abolished by clopidogrel pretreatment. Two-weeks’ clopidogrel treatment decreased V while UosmUosmV and UNaV increased, most distinctly after 7 days. Acute clopidogrel infusion modestly decreased mean arterial pressure and significantly increased outer- and decreased inner-medullary perfusion.ConclusionsOur functional studies show that ADP can cause systemic and renal vasodilation and a decrease in mean arterial pressure, an action at least partly mediated by P2Y12 receptors. We confirmed that these receptors exert tonic action to reduce tubular water reabsorption and urine concentration.
       
  • Cardiovascular Parameters Associated With Troponin I as Indicators for
           14-Day Mortality in Patients With Septic Shock
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): Wen-Lin Su, Hao-Ai Shui, Chou-Chin Lan, Mei-Chen Yang, Chien-An Hsieh, Shih-Jung Jang, Hsueh-Wen Chung, Yao-Kuang Wu BackgroundTroponin I is better than other troponin isoforms for monitoring cardiocyte damage, and correlates with sepsis-related mortality. However, hemodynamic factors possibly interact with cardiac function to affect mortality in sepsis. Thus, this study used parameters from pulse-induced contour cardiac output (PiCCO) to investigate the possibility.MethodsPatients with troponin I tests and sequential organ failure assessment score ≥2 were selected and divided into survivors and nonsurvivors groups and blood troponin I levels between them were compared. Additionally, 65 patients with septic shock and PiCCO records were selected and divided into high cardiac function index (CFI) and low CFI groups and their cardiac function associated with troponin I levels was checked. Furthermore, the patients were classified into 4 subgroups based on CFI and another hemodynamical parameter of PiCCO for identifying if any interaction between CFI and the parameter existed.ResultsHigh blood troponin I levels correlated with high mortality, and with low cardiac function (CFI < 4.5) alone or with low CFI combined with high stroke volume variation (SVV), but did not correlate with global end-diastolic index (GEDI), or systemic vascular resistance index. However, only the subgroup with low CFI and high SVV (CFI < 4.5 and SVV> 10) increased mortality.ConclusionsOur data give an insight into interactions between cardiac and hemodynamic factors to cause cardiocyte damage and suggest that multiple factors (i.e., low CFI and high SVV) should be considered together to evaluate cardiocyte damage and mortality in sepsis.
       
  • The King Is Dead: Clark Gable’s Heart Attack
    • Abstract: Publication date: September 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 3Author(s): Robert S. Pinals, Harold Smulyan Clark Gable was born in a small Ohio mining town and never finished high school. Stage struck as a young man, he did menial jobs while working his way up to movie stardom—his most famous role was in “Gone with the Wind.” He married 5 times. During WWII, he enlisted in the Army Air Corps, flew a few combat missions as a gunner and won the Distinguished Service Cross. Personally, he was intermittently obese, a drinker, smoker, hypertensive and predictably in 1960, he suffered an acute myocardial infarction. His clinical course was benign until the 10th hospital day, when he died suddenly. No resuscitation was attempted. At the time of his death, preventive cardiology, mouth-to-mouth ventilation, closed chest cardiac massage, defibrillation and coronary care units were in their infancy. The history of these and subsequent therapeutic practices are reviewed, but Gable died a bit too early for their application.
       
  • Errata
    • Abstract: Publication date: Available online 29 September 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • THE ARCHETYPES OF MEDICINE A Job Description for the 21st
           Century
    • Abstract: Publication date: Available online 27 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Salvatore Mangione, Jennifer Fisher Wilson, Steven K. HerrineABSTRACTMedicine is facing an identity crisis, one that might find resolution by revisiting a past rich in multifaceted individuals who transcended the strict definition of 'doctor', excelled in other fields of human endeavor, and showed us different ways of being physicians. This paper reviews 12 archetypes that have been part of the profession since its inception, but that, as of late, might have been forgotten. Our goal is to elicit discussion and introspection, with the premise that being a physician ought to be something larger than being a mere technician. If our premise is accepted, then the next step would be to identify those personal traits that made those archetypes possible, so that we can start both recruiting for them and then nurturing them during training.
       
  • A Brief Meta-analysis of Oxygen Therapy for Normoxemic Patients with Acute
           Coronary Syndrome
    • Abstract: Publication date: Available online 25 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Rahman Shah, Sarah M. Wilson, Mallie M. Dennis, Babar Khan, Samuel B. Latham
       
  • Disseminated tuberculosis in the differential diagnosis of hemophagocytic
           syndrome
    • Abstract: Publication date: Available online 20 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Oscar M P Jolobe
       
  • Mega journals, scientifically sound peer review, and medical organizations
    • Abstract: Publication date: Available online 19 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Kenneth Nugent, Hawa Edriss, Somedeb Ball, Bo-Christer Björk
       
  • Metformin Associated with Improved Outcomes in Diabetic Patients with
           Laryngeal and Oropharyngeal Carcinoma
    • Abstract: Publication date: Available online 13 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Amie Ogunsakin, Jordan Infield, Jeffery Zuber, Solomon S. Solomon
       
  • Acute Pancreatitis due to a rare ductal anomaly: ansa pancreatica
    • Abstract: Publication date: Available online 13 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Houssem Harbi, Nozha Toumi, Mohamed Ben Amar
       
  • The Dust Bowl in the US: An Analysis Based on Current Environmental and
           Clinical Studies
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Robert Alexander, Connie Nugent, Kenneth Nugent The Dust Bowl occurred in the Central Plains states in the United States between 1930 and 1940. Prolonged drought, intense recurrent dust storms and economic depression had profound effects on human welfare. The causes included increased farming on marginal land, poor land management, and prolonged drought. There was a significant increase in the number of cases of measles, increased hospitalization for respiratory disorders and increased infant and overall mortality in Kansas during the Dust Bowl. Recent scientific studies have demonstrated that dust transmits measles virus, influenza virus and Coccidioides immitis, and that mortality in the United States increases following dust storms with 2-3-day lag periods. Advances in technology have provided information about the composition of dust and the transfer of microbial pathogens in dust and provided the framework for reducing the economic and health consequences of the next prolonged drought in the United States.
       
  • Central Retinal Artery Occlusion Following Hyaluronic Acid Fillers
           Injection
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Ji-Long Hao, Om Prakash Pant, Cheng-Wei Lu
       
  • The American Journal of the Medical Sciences Editorial Office
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s):
       
  • Kallmann Syndrome With Micropenis
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Chia-Po Fu, I-Te Lee
       
  • Recurrent Severe Hypoinsulinemic Hypoglycemia Responsive to Temozolomide
           and Bevacizumab in a Patient With Doege-Potter Syndrome
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Amie A. Ogunsakin, Holly L. Hilsenbeck, David C. Portnoy, Ebenezer A. Nyenwe Nonislet cell tumor hypoglycemia is rare. We highlight the diagnosis and treatment of recurrent severe hypoglycemia in a 49-year-old woman with malignant solitary fibrous tumor of the pleura (Doege-Potter syndrome). The clinical, laboratory and radiologic findings of the case are presented and a brief literature review is provided. Of note, imaging studies showed a large mass in the right hemithorax and pathology and immunehistochemical stains confirmed a malignant solitary fibrous tumor of the pleura. She was a poor surgical candidate owing to a large tumor burden. She was treated with a combination of temozolomide and bevacizumab to which she responded with resolution of hypoglycemia. The treatment of choice for hypoglycemia in patients with the Doege-Potter syndrome is surgical excision. We here report that a combination of temozolomide and bevacizumab may be a viable option in patients with inoperable disease.
       
  • Evaluation and Management of Gross Hematuria in Autosomal Dominant
           Polycystic Kidney Disease: A Point of Care Guide for Practicing Internists
           
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Bhavna Bhasin, Mohammed Alzubaidi, Juan Carlos Q. Velez Gross hematuria is common in autosomal dominant polycystic kidney disease (ADPKD). It is an alarming symptom and may be the first manifestation of ADPKD. Cyst hemorrhage is a frequent cause of hematuria in ADPKD while other differential diagnoses include cyst infection, urinary tract infection, renal stones and an underlying malignancy. Knowledge of the precipitating factors and clinical presentation of these conditions will help practicing internists in performing an appropriate evaluation and management of these entities and their complications, as well as executing timely referrals to subspecialists when indicated.
       
  • Silent Information Regulator 1 Negatively Regulates Atherosclerotic
           Angiogenesis via Mammalian Target of Rapamycin Complex 1 Signaling Pathway
           
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Runtai Chen, Zhenchun Huang, Junyi Wang, Xiaoying Chen, Yucai Fu, Wei Wang BackgroundThis study aimed to investigate the interactions between silent information regulator 1 (SIRT1) and mammalian target of rapamycin (mTOR) in intraplaque angiogenesis and their potential mechanisms through in vivo and in vitro studies.MethodsAn atherosclerosis model was established in 12 rabbits on a high-cholesterol diet. The rabbits were equally divided into 3 groups: a control group (high-lipid diet), RAP group (high-lipid diet supplemented with rapamycin) and RAP + NAM group (high-lipid diet supplemented with rapamycin and nicotinamide). At the end of 4 weeks, the area of plaques in the aorta was determined and the protein expression of CD31 and vascular endothelial growth factor (VEGF) was detected through hematoxylin and eosin staining and immunohistochemical staining, respectively. For in vitro study, a hypoxia model was established in human umbilical vein endothelial cells (HUVECs) by using the chemical method (CoCl2). The MTT assay, scratch assay and tube formation assay were performed to evaluate the proliferation and angiogenesis abilities of HUVECs. Reverse transcription polymerase chain reaction was used to examine the mRNA levels of SIRT1, hypoxia-inducible factor-1α (HIF-1α), mTOR and p70 ribosomal S6 kinase (p70S6K). Western blotting was used to examine the protein levels of SIRT1, HIF-1α, mTOR, p-mTOR, p-raptor and p-p70S6K.ResultsThe results of the in vivo study indicated a significant inhibitory effect of rapamycin on plaque size and intraplaque angiogenesis (0.05 ± 0.02 mm2 versus 5.44 ± 0.50 mm2, P < 0.05). This effect was attenuated by nicotinamide (0.76 ± 0.15 mm2 versus 0.05 ± 0.02 mm2, P < 0.05). Compared with the RAP group, CD31- and VEGF-positive vessels were abundant in the RAP + NAM group. The RAP group showed lower expression of p-mTOR, p-p70S6K and HIF-1α than did the control group (P < 0.05), whereas the RAP + NAM group showed slightly higher expression of these factors than did the RAP group (P < 0.05). Furthermore, in vitro studies revealed that the inhibitory effect of rapamycin on the angiogenic ability of HUVECs and its significant inhibitory effects on the protein level of HIF-1α and the phosphorylation of proteins involved in the mTORC1 pathway, including mTOR, raptor and p70S6K (P < 0.05), were enhanced by cotreatment with SRT1720 and rapamycin (P < 0.05). In contrast to mTOR and SIRT1, the mRNA levels of p70S6K and HIF-1α were reduced by rapamycin (P < 0.05) and further reduced by cotreatment with SRT1720 and rapamycin.ConclusionsThe study results indicate that SIRT1 might negatively regulate atherosclerotic angiogenesis via mTORC1 and HIF-1α signaling pathway and cointervention of SIRT1 and mTOR may serve as a crucial therapeutic strategy in cardiovascular medicine.
       
  • Gender-Specific Association of Leptin and Adiponectin Genes With Multiple
           Sclerosis
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Marziyeh Yousefian, Reza Nemati, Gholamreza Daryabor, Naser Gholijani, Alireza Nikseresht, Afshin Borhani-Haghighi, Eskandar Kamali-Sarvestani BackgroundAdipocytokines such as leptin (LEP) and adiponectin (ADIPOQ) represent a link between metabolism, nutritional status and immune responses. The present study aimed to determine the possible association between single nucleotide polymorphisms of LEP and ADIPOQ genes with multiple sclerosis (MS).Materials and methodsSingle nucleotide polymorphisms in LEP (rs2167270 or 19G> A and rs7799039 or −2,548G> A) and ADIPOQ (rs1501299 or +276G> T and rs266729 or −11,377C> G) were genotyped in 305 patients and 255 healthy individuals using polymerase chain reaction-restriction fragment length polymorphism. Sera levels of leptin and adiponectin were measured using enzyme-linked immunosorbent assay.ResultsThe frequencies of low leptin producer rs2167270GG genotype and rs2167270G allele were significantly lower in patients with MS compared to those of controls (for GG genotype: 39.7% and 49.8%, respectively; P = 0.01; for G allele: 63.3% and 68.8%, respectively; P = 0.05). Both polymorphisms in ADIPOQ did not show any significant association with disease susceptibility, though after gender categorization the frequency of high adiponectin producer rs1501299TT genotype and rs1501299T allele were significantly higher in male controls compared to male patients (TT genotype: P = 0.006; T allele: P = 0.006). Additionally, rs1501299TT genotype in ADIPOQ was associated with susceptibility to primary progressive multiple sclerosis (PP-MS) (P = 0.02). Moreover, while the sera levels of leptin were only different between male patients and controls (P = 0.05), adiponectin levels were significantly higher in total and female healthy controls (P < 0.001, P = 0.002, respectively).ConclusionsOur findings provide evidence to support the hypothesis that functional ADIPOQ and LEP gene polymorphisms are associated with susceptibility to MS and its clinical forms.
       
  • Postthrombotic Syndrome: Long-Term Sequela of Deep Venous Thrombosis
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Abdelmoniem Moustafa, Hussam Mohammad Alim, Mohammed Andaleeb Chowdhury, Ehab A. Eltahawy Postthrombotic syndrome is a common long-term complication of proximal lower extremity deep venous thrombosis, which not only significantly affects the quality of life of patients but also imposes a substantial financial burden on our healthcare system. Due to limited awareness and inability of physicians to recognize and treat this condition early, its prevalence is steadily increasing. In this article, we review the pathophysiology, the risk factors involved, diagnostic workup, and the various management options available to treat this condition.
       
  • Modifiable Predictors of In-Hospital Mortality in Patients Undergoing
           Transcatheter Aortic Valve Replacement
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Oluwaseun A. Akinseye, Muhammad Shahreyar, Chioma C. Nwagbara, Mannu Nayyar, Salem A. Salem, Mohamed Morsy, Rami N. Khouzam, Uzoma N. Ibebuogu BackgroundTranscatheter aortic valve replacement (TAVR) has become an acceptable therapy for patients with severe aortic valve stenosis at high or prohibitive surgical risk. Attempts are ongoing to validate risk prediction models for in-hospital mortality after TAVR. Our aim was to define modifiable risk factors predictive of in-hospital mortality after TAVR.MethodsWe identified patients who underwent TAVR from the 2012 database of the National Inpatient Sample. Patients who died during the index hospitalization were compared to those that were successfully discharged. The predictors of in-hospital mortality were analyzed using multivariate logistic regression.ResultsA total of 1,360 patients (mean age 81 ± 8.8 years, whites 80.1%, blacks 3.5%) had TAVR and 68 (5%) died during hospitalization (χ2 [1, n = 1,360] = 1,101.6, P < 0.001). The average length of hospital stay was 8.33 ± 6.7 days. The positive predictors of in-hospital mortality in the unadjusted model were comorbidities such as congestive heart failure, coagulopathy, fluid and electrolyte disorder, weight loss and history of drug abuse. Hypertension was a negative predictor of in-hospital mortality. Following multivariate analysis and adjustment for possible confounders, fluid and electrolyte disorder was the only significant positive predictor of in-hospital mortality (odds ratio = 1.89, CI: 1.11-3.22, P = 0.019). The odds of in-hospital mortality were reduced in patients with hypertension (odds ratio = 0.45, CI: 0.26-0.78, P = 0.004).ConclusionsFluid and electrolyte disturbance could be a modifiable predictor of in-hospital mortality following TAVR. Efforts should be geared towards reducing its occurrence in this patient population.
       
  • Correlations of Circulating Cell-Free DNA With Clinical Manifestations in
           Acute Myocardial Infarction
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Jin Xie, Jiawei Yang, Pei Hu BackgroundThe objective of the study was to examine the potential use of circulating cell free DNA (cfDNA) in acute myocardial infarction (AMI) patients and correlate it with clinical features. Serial monitoring was conducted to assess any associations to disease.MethodsQuantification of cfDNA was performed on 130 cardiovascular disease (CVD) patients as well as 30 healthy volunteers. Serial samplings were conducted using PicoGreen dsDNA assay. Of the 130 patients with CVD, 100 had an AMI and measurements were taken during treatment. Short and medium intervals serial sampling of patients’ blood were undertaken.ResultsThe results were highly correlative of CVD disease status. The mean concentration of cfDNA in patients with AMI was 5 folds higher during the onset of disease compared with healthy volunteers. The cfDNA content was also higher than other patients with CVD. Interestingly, short term monitoring of patients with AMI showed distinct trends that highlighted the severity of the disease and linked to complication events. Medium term monitoring showed 2 distinctive groups with 1 that had their cfDNA returned to basal levels and the other with persistently elevated cfDNA levels.ConclusionsMeasuring cfDNA in patients with CVD offers an alternative approach to monitor the disease and has potential clinical applications to identify high-risk individuals.
       
  • Coding and Noncoding Variants in CFH Act Synergistically for Complement
           Activation in Immunoglobulin A Nephropathy
    • Abstract: Publication date: August 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 2Author(s): Wei-yi Guo, Qing-zhen Liu, Li Zhu, Zeng-yan Li, Si-Jun Meng, Su-fang Shi, Li-Jun Liu, Ji-Cheng Lv, Ping Hou, Hong Zhang BackgroundIn immunoglobulin A nephropathy (IgAN), complement activation occurs in both the systemic circulation and in situ (glomerular). A recent IgAN-genome-wide association study (GWAS) identified 1q32 as an IgAN susceptible locus that contained the complement regulatory protein coding gene complement factor H (CFH). Here, we explored the combined genetic effects of coding and noncoding variants in CFH, rs6677604 and rs800292 on complement activation in IgAN.MethodsIn total, 1,194 IgAN patients and 900 healthy controls who were the same as the Beijing Discovery Cohort in our recent IgAN-GWAS were recruited. The genotyping information of rs800292 and rs6677604 were extracted from GWAS data, while the information regarding plasma C3 levels and mesangial C3 deposits were collected from medical records.ResultsWe found both rs800292-GG and rs6677604-GG were risk genotypes for complement activation in IgAN patients, as represented by lower plasma C3 levels in IgAN patients with rs800292-GG and a higher intensity of glomerular C3 deposits in those with rs6677604-GG, respectively. Additionally, IgAN patients with 2 risk genotypes (rs800292-GG and rs6677604-GG) showed a higher degree of complement activation compared to those with no risk genotypes (rs800292-AA/AG and rs6677604-AA/AG), as represented by both lower plasma C3 levels and a higher intensity of glomerular C3 deposits. Moreover, when compared to rs800292 or rs6677604 alone, the combined genetic effects of rs800292 and rs6677604 showed a stronger association with IgAN susceptibility.ConclusionsOur findings suggested that both coding and noncoding variants in CFH acted synergistically to regulate the degree of complement activation and thereby contributed to IgAN susceptibility.
       
  • Clinical Efficacy of Serum-Derived Bovine Immunoglobulin in Patients with
           Refractory Inflammatory Bowel Disease
    • Abstract: Publication date: Available online 5 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Hammad Liaquat, Munish Ashat, Abigail Stocker, Lindsay McElmurray, Karen Beatty, Thomas L. Abell, Gerald Dryden BackgroundInflammatory bowel disease (IBD) can have autoimmunity and/or intestinal barrier dysfunction as part of pathophysiology and may be refractory to all available treatment options. Serum-derived bovine immunoglobulin/protein isolate (SBI) binds microbial components with postulated downstream effects of normalized gut immune and barrier function which may be useful for managing IBD. The purpose of our study was to evaluate the effectiveness of SBI in the management of refractory IBD, particularly symptoms of chronic diarrhea and loose stools.MethodsWe retrospectively analyzed charts for patients diagnosed with IBD (n = 40) who were refractory to standard treatment. Patients received oral SBI 5 gram daily for a period of at least 6 weeks. Twelve patients with IBD fulfilled study inclusion criteria. Each patient graded the severity and frequency of gastrointestinal symptoms before starting SBI and at 6 weeks of treatment using a standardized patient assessment form. Means and standard deviations for all symptom scores at baseline and week 6 of treatment were analyzed.ResultsMean symptom scores decreased significantly for nausea (P = 0.02 for severity and P = 0.03 for mean symptom score) and diarrhea (P = 0.0006, P = 0.0001 and P = 0.0001 for severity, frequency and mean symptom score, respectively).ConclusionTherapy with SBI alleviated some refractory gastrointestinal symptoms in patients with IBD, including nausea and diarrhea. Increased duration, dosage and/or frequency of SBI might provide additional symptom improvement and could be tested through controlled clinical trials with larger sample sizes and longer follow up.
       
  • Current Evidence in Delivery and Therapeutic Uses of Fecal Microbiota
           Transplantation in Human Diseases – Clostridium difficle disease and
           beyond
    • Abstract: Publication date: Available online 5 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Joshua Stripling, Martin Rodriguez
       
  • The Properties of Cytokine in Multiple Sclerosis: Pros and Cons
    • Abstract: Publication date: Available online 5 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Kexin Wang, Feng Song, Alejandro Fernandez-Escobar, Gang Luo, Jun-hui Wang, Yu Sun Multiple sclerosis is a chronic autoimmune disease that affects the central nervous system and is characterized by demyelination, axonal loss, gliosis, and inflammation. The last plays a major role in the onset and propagation of the disease. Multiple sclerosis presents with heterogeneous lesions containing a broad range of cells and soluble mediators of the immune system such as T cells, B cells, macrophages, microglia, cytokines, chemokines, antibodies, complement, and other toxic substances. This review outlines, analyzes, and discusses the different immune mechanisms of MS that are responsible for the initiation and propagation of active lesions, demyelination, axonal injury, remyelination, and cell loss as well as the role of cytokines in the disease process. Pro-inflammatory cytokines such as Interleukin-17 (IL-17), IL-22, tumor necrosis factor-α, IL-1, IL-12, and interferon-γ may cause multiple sclerosis through several signaling pathways. Conversely, anti-inflammatory circulating cytokines such as IL-4 and IL-10 are reduced and theoretically can exert a direct protective effect in this condition. Future studies are necessary to develop effective, safe, and long-lasting strategies to reduce the abnormal cytokine cascades and to treat multiple sclerosis.
       
  • The Birth of Angiotensin: An International Compromise
    • Abstract: Publication date: Available online 4 September 2018Source: The American Journal of the Medical SciencesAuthor(s): Harold Smulyan, Daniel Villarreal Irvine Page in the United States and Eduardo Braun-Menéndez in Argentina led teams of investigators that studied the role of the kidney in blood pressure regulation. Contemporaneously in 1939, each team using different methods discovered and described a new substance now known as angiotensin. At the time of discovery, Page called it “angiotonin” and Braun-Menéndez called it “hipertensina”, anglicized to “hypertensin”. Over time, the importance of this substance in circulatory control, pathophysiology and pharmacology became indisputable and the need for a single name became obvious. In a remarkable accommodation, Page and Braun-Menéndez agreed to forego any claim to priority and chose a name with elements of both. Following this compromise, Page and Braun-Menéndez went on to become leaders in science in their own countries as well as recognition world-wide while angiotensin and its derivatives have become standard components in the understanding and treatment of diseases of the heart, kidney and brain.
       
  • Lupus and Cardiovascular Disease
    • Abstract: Publication date: Available online 31 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Jan Nilsson
       
  • The use of microbiome restoration therapeutics to eliminate intestinal
           colonization with multidrug-resistant organisms
    • Abstract: Publication date: Available online 29 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Srinivasa Nithin Gopalsamy, Michael H. Woodworth, Tiffany Wang, Cynthia T. Carpentieri, Nirja Mehta, Rachel J. Friedman-Moraco, Aneesh K. Mehta, Christian P. Larsen, Colleen S. Kraft Antibiotic resistance (AR) has been described by the World Health Organization as an increasingly serious threat to global public health. Many mechanisms of AR have become widespread due to global selective pressures such as widespread antibiotic use. The intestinal tract is an important reservoir for many multidrug-resistant organisms (MDROs) and next-generation sequencing has expanded understanding of the resistome, defined as the comprehensive sum of genetic determinants of AR. Intestinal decolonization has been explored as a strategy to eradicate MDROs with selective digestive tract decontamination and probiotics being notable examples with mixed results. This review focuses on fecal microbiota transplantation (FMT) and the early evidence supporting its efficacy in decolonizing MDROs and potential mechanisms of action to reduce AR genes. Current evidence suggests FMT may have promise in restoring healthy microbial diversity and reducing AR, and clinical trials are underway to better characterize its safety and efficacy.
       
  • Correlations of microRNA-21 Gene Polymorphisms with Chemosensitivity and
           Prognosis of Cervical Cancer
    • Abstract: Publication date: Available online 29 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Jing Zhang, Yan-Hua Li, Hong-Li Liu, Yuan Zhang, Qing-Song Zhang, Sheng-Ze Li BackgroundWe investigated correlations of miR-21 gene polymorphisms including rs1292037 (A> G) and rs13137 (A> T) with the chemosensitivity to cisplatin plus paclitaxel, and prognosis before cervical cancer (CC) surgery, which may provide a novel target for prevention and treatment of CC.MethodsA total of 165 patients with CC were divided into 2 groups, a sensitive group and resistance group. Gene polymorphisms of rs1292037 (A> G) and rs13137 (A> T) were detected respectively. Logistic and Cox multivariate regression analyses were used to explore factors that influence resistance to cisplatin plus paclitaxel.Resultsrs1292037 (A> G) locus AG, GG, AG + GG and G allele in miR-21 gene may increase chemoresistance to cisplatin plus paclitaxel in CC. The risk factors of prognosis included rs1292037 (A> G) locus, tumor stage, maximum lesion diameter and LNM (hazard ratio [HR] = 1.819, 95% CI = 1.127-2.935; HR = 1.504, 95% CI = 1.070-2.114; HR = 1.671, 95% CI = 1.038-2.689; HR = 3.043, 95% CI = 1.783-5.193). The influencing factors of resistance to cisplatin plus paclitaxel included maximum lesion diameter, tumor stage, lymph node metastasis (LNM) and rs1292037 (odds ratio [OR] = 14.047, 95% CI = 5.694-34.653; OR = 5.873, 95% CI = 3.104-11.110; OR = 3.574, 95% CI = 1.554-8.216; OR = 2.449, 95% CI = 1.052-5.705).Conclusionrs1292037 (A> G) locus are associated with the chemoresistance to cisplatin plus paclitaxel and prognosis of patients with CC. In addition to that, the G allele at rs1292037 (A> G) locus increases the risk of preoperative chemoresistance to cisplatin plus paclitaxel and is a poor prognostic factor for patients with CC.
       
  • IgG4-related pleuritis without tuberculous pleurisy
    • Abstract: Publication date: Available online 28 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Toshiyuki Kita
       
  • We Care About Patient-Reported Outcomes, But We Don't Communicate with our
           Patients
    • Abstract: Publication date: Available online 27 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Devika Nair
       
  • Putting the CAP on ICU admissions: Can clinical prediction tools help
           determine appropriate site of care'
    • Abstract: Publication date: Available online 22 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Frances Mae West, Bharat K. Awsare
       
  • Ewing's sarcoma/peripheral primitive neuroectodermal tumors in bronchus
    • Abstract: Publication date: Available online 22 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Jun Chen, Tao Yuan, Xiao Liu, Bei Hua, Chenfeng Dong, Yawu Liu, Guanmin Quan Ewing sarcoma/peripheral primitive neuroectodermal tumors (ES/pPNET), a member of the Ewing sarcoma family of tumors, is a malignant soft tissue tumor with small undifferentiated neuroectodermal cells. Primary trachea-bronchial ES/pPNET is very rare. The most common pulmonary ES is due to a metastasis. We describe a case of ES/pPNET which originated in the left basal trunk bronchus. The patient was a 30-year-old male, presenting with irritable cough and fever for 10 days. A tumor of 60 mm in diameter was found in the left basal trunk bronchus, extending to the left lower lobe. No distant metastases were detected. Histopathological examination revealed a malignancy of ES/pPNET with a diffuse proliferation of round cells, a Flexner-Wintersteiner rosette formation and positive staining for CD99. The patient was successfully treated with a combination of left lower lobectomy and adjuvant chemotherapy and has remained disease-free for approximately 18 months at follow-up. This case highlights that ES/pPNET should be considered as a differential diagnosis in cases of trachea-bronchial tumors.
       
  • Study of The Microbiome has Reached Prime Time
    • Abstract: Publication date: Available online 22 August 2018Source: The American Journal of the Medical SciencesAuthor(s): C. Mel Wilcox
       
  • A patient-centered approach to care in chronic disease
    • Abstract: Publication date: Available online 21 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Jeffrey J. Swigris
       
  • DEVELOPMENT OF THE PEDIATRIC GUT MICROBIOME: IMPACT ON HEALTH AND DISEASE
    • Abstract: Publication date: Available online 21 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Faith D. Ihekweazu, James VersalovicABSTRACTThe intestinal microbiota are important in proper human growth and development before and after birth, during infancy and childhood. Microbial composition may yield insights into the temporal development of microbial communities and vulnerabilities to disorders of microbial ecology such as recurrent Clostridium difficile infection. Discoveries of key microbiome features of carbohydrate and amino acid metabolism are lending new insights into possible new therapies or preventative strategies for inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). In this review, we summarize the current understanding of the development of the pediatric gastrointestinal microbiome, the influence of the microbiome on the developing brain through the gut-brain axis, and the impact of dysbiosis on the development of disease. Microbial dysbiosis will be explored in the context of pediatric allergy and asthma, recurrent C. difficile infection, IBD, IBS, and metabolic disorders. The central premise is that the human intestinal microbiome plays a vital role throughout human life beginning in the prenatal period and extending throughout childhood in health and disease.
       
  • Priority for treatment and intensive care of patients with non-severe
           community-acquired pneumonia
    • Abstract: Publication date: Available online 7 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Hai-yan Li, Qi Guo, Wei-dong Song, Yi-ping Zhou, Ming Li, Xiao-ke Chen, Hui Liu, Hong-lin Peng, Hai-qiong Yu, Xia Chen, Nian Liu, Zhong-dong Lü, Li-hua Liang, Qing-zhou Zhao, Mei Jiang BackgroundThe Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is unclear whether the patients with non-severe CAP meeting the minor criteria most strongly associated to mortality should have the priority for treatment and intensive care. It is warranted to explore this intriguing hypothesis.MethodsA retrospective cohort study of 1230 patients with CAP was performed. This was tested against a prospective 2-center cohort of 1749 adults with CAP.ResultsThe patients with CAP fulfilling the predictive findings most strongly associated to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality rates than those not fulfilling the predictive findings in subgroup analyses of the retrospective cohort. The more the number of predictive findings present, the higher the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly, the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly higher mortality rates compared with the patients with severe CAP not meeting the predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort. Two similar and intriguing paradigms about sequential organ failure assessment (SOFA) scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts.ConclusionsThe patients with non-severe CAP fulfilling the predictive findings most strongly associated to mortality demonstrated higher SOFA and PSI scores and mortality rates, and might have the priority for treatment and intensive care.
       
  • Broadening the differential diagnosis of IgG4-related pleuritis
    • Abstract: Publication date: Available online 6 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Oscar M.P. Jolobe
       
  • Honiton laces in oral cavity
    • Abstract: Publication date: Available online 1 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Shelly Arora, Ranjeet Ajit Bapat, Tanay Chaubal
       
  • Mitigation of stroke risk in nonvalvular atrial fibrillation patients with
           high grade carotid artery stenosis
    • Abstract: Publication date: Available online 1 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Oscar M P Jolobe
       
  • Risk Factors for Low Pharmacy Refill Adherence among Older Hypertensive
           Men and Women by Race
    • Abstract: Publication date: Available online 29 July 2018Source: The American Journal of the Medical SciencesAuthor(s): LaKeisha G. Williams, Erin Peacock, Cara Joyce, Lydia A. Bazzano, Daniel Sarpong, Paul K. Whelton, Elizabeth W. Holt, Richard Re, Edward Frohlich, Jiang He, Paul Muntner, Marie Krousel-Wood BackgroundSex-race stratification may lead to identification of risk factors for low antihypertensive medication adherence that are not apparent when assessing risk factors in women and men without race stratification. We examined risk factors associated with low pharmacy refill adherence across sex-race subgroups (white women, black women, white men, black men) within the Cohort Study of Medication Adherence among Older Adults (n=2,122).MethodsPharmacy refill adherence was calculated as proportion of days covered (PDC) using all antihypertensive prescriptions filled in the year prior to a baseline risk factor survey. Sex- and sex-race-stratified multivariable Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios and 95% confidence intervals for associations between participant characteristics and low adherence.ResultsPrevalence of low adherence was 22.9% versus 40.7% in white versus black women (p
       
  • Emerging role for exosomes in the progress of stem cell research
    • Abstract: Publication date: Available online 19 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Yuan Kai-Ming, Zhang Pei-Hua, Qi Shan-Shan, Zhu Qiao-Zhen, Li Ping Exosomes are small secretory vesicles that are involved in intercellular communication. Exosomes are secreted by many types of cells and exert important functions in plasma-membrane exchange as well as the transport of bioactive substances, such as proteins, messenger ribonucleic acids (mRNAs), micro ribonucleic acids (miRNAs) and organelles. Exosomes may regulate physiological processes by altering gene regulatory networks or epigenetic recombination. Recent studies have shown that exosomes secreted by stem cells can effectively transport proteins, mRNAs and miRNAs and play important roles in the regulation of tissue regeneration. This report reviews current progress in exosome studies as well as their emerging roles in stem cell research and potential clinical use.
       
  • The Acute effects of cigarette smoking on the functional state of high
           density lipoprotein
    • Abstract: Publication date: Available online 19 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Si-Qi Shen, Hui Chang, Zi-Xi Wang, Hong-Ying Chen, Lian-Feng Chen, Feng Gao, Xiao-Wei Yan BackgroundCigarette smoking disturbs plasma lipid level and lipoprotein metabolism; however, the effects of smoking on the functional state of high density lipoprotein (HDL) are still not clear. This study aimed to determine the anti-oxidant and anti-chemotactic properties of HDL and HDL-mediated cholesterol efflux in healthy subjects after cigarette smoking.MethodsHealthy male subjects, including nonsmokers (n=16) and chronic smokers (n=8), were enrolled. After smoking 8 cigarettes within 2 hours, plasma HDL was isolated and tested. Copper-induced LDL oxidation was used to determine the anti-oxidant ability of HDL. The concentration of SAA was measured by ELISA. Chemotaxis was detected by transwell assay. HDL-mediated cholesterol efflux was measured using fluorescent cholesterol analog.ResultsLow density lipoprotein (LDL) baseline oxidation state was higher in chronic smokers than that in nonsmokers. Meanwhile, HDL-induced cholesterol efflux in macrophages in chronic smokers was significantly enhanced compared with that in nonsmokers. After acute smoking, both the anti-oxidant and anti-chemotactic ability of HDL declined in nonsmokers. However, in healthy chronic smokers, the effect of HDL on the susceptibility of LDL to oxidation was compensatorily enhanced. Nevertheless, their bodies were still in a higher oxidation state. Also, acute smoking did not affect HDL-mediated cholesterol efflux significantly in both nonsmokers and chronic smokers.ConclusionsOur data suggest that acute smoking attenuates the anti-oxidant and anti-chemotactic abilities of HDL in nonsmokers. Chronic smokers are in a higher oxidative state, although the anti-oxidant function of their HDL is compensatorily enhanced.
       
  • Hemophagocytic lymphohistiocytosis in the elderly
    • Abstract: Publication date: Available online 17 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Reyna Altook, Mohammed Ruzieh, Avneet Singh, Wael Alamoudi, Zeinab Moussa, Hussam Alim, Fadi Safi, Joan Duggan Hemophagocytic lymphohistiocytosis (HLH) is a rare disease of massive, dysregulated cytokine release and secondary multi-organ failure, and is associated with high mortality. Primary HLH occurs predominately in infants and young children with a genetic predisposition. Acquired HLH is less well characterized and usually occurs in younger adults in the setting of severe inflammation triggered by infection or malignancy. Little is known about the disease in elderly. We report 3 patients>50 years old who presented with multi-organ failure and shock without an identifiable source and were ultimately diagnosed with acquired HLH. We performed a literature review of HLH in adults>50 years of age and identified an additional 68 cases. Mean age was 62 years, with male predominance. Most cases were triggered by infection (49%) followed by malignancy (27%). Nineteen patients were treated with the HLH-94 protocol, 11 received corticosteroids and the remainder received non-HLH specific interventions. Overall mortality was 62%.
       
  • The clinical impact of glomerular immunoglobulin M deposition in patients
           with type 2 diabetic nephropathy
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Xi Tang, Hanyu Li, Li li, Junlin Zhang, Huan Xu, Lin Li, Fang Liu BackgroundGlomerular Immunoglobulin M (IgM) deposition is common in diabetic kidney disease. The clinical implication of IgM deposition in the renal tissues of type 2 diabetes (T2DM) patients with biopsy-proven diabetic nephropathy (DN) remains unclear.MethodsOne hundred thirty-two patients with T2DM and biopsy-proven pure DN were enrolled retrospectively. Clinicopathological features and renal outcomes were compared between patients with and without glomerular capillary IgM deposition. A Cox proportional hazards model was employed to identify the risk factors associated with renal survival.ResultsFifty-two patients had positive linear glomerular capillary IgM staining. Patients with glomerular capillary IgM deposition presented with heavier proteinuria, lower serum albumin, and lower immunoglobulin G (IgG) levels. During 35.5 (12, 107) months of follow-up, patients with glomerular tuft IgM deposition had shorter renal survival than those with negative IgM deposition (39 [23.74, 54.26] vs. 64 [45.82, 82.18] months, P = 0.01). Patients with glomerular C1q deposition showed worse renal survival than those lacking glomerular C1q deposition (36 [23.82, 48.18] vs. 60 [50.27, 69.74] months, P = 0.001). Worse renal outcome was observed in patients with glomerular C3 deposition than in those without glomerular C3 deposition (37 [22.43, 51.56] vs. 63 [51.75, 74.25] months, P = 0.001). Multivariate Cox proportional analysis demonstrated that combined glomerular capillary IgM and C1q deposition (HR 3.75, 95% CI [1.68, 8.35], P = 0.001) was an independent predictor of end-stage renal disease.ConclusionsPatients with diabetic nephropathy and combined glomerular capillary IgM and C1q deposition had unfavorable renal outcome, which indicates that IgM derived from B cells might be involved in diabetic kidney injury.
       
  • Does Timing Matter' Using Lactate to Predict Outcomes
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Michael Baram, Bharat Awsare
       
  • A case of Takayasu Arteritis with the ostium of left main coronary artery
           obstructed by prolapsed thickened ascending aortic intima
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Jiayue Feng, Sen He, Hua Wang
       
  • Walter Reed at Camp Lazear: A Paradigm for Contemporary Clinical Research
    • Abstract: Publication date: Available online 5 July 2018Source: The American Journal of the Medical SciencesAuthor(s): David Ploth Throughout the time of the early settlement and development of North America there were frequent epidemics of Yellow Fever. Yellow fever was particularly threatening because it was associated with an extremely high mortality rate; up to 85% of those infected died of the disease. Yellow Fever in the Western world is likely an additional, horrific by-product of early slavery in North America. It is thought that ships transporting captured Africans likely conveyed both the major vector, the Aedes aegypti mosquito, and the RNA Yellow Fever virus from Africa to North America. Infected ships landing in port cities resulted in epidemics that proved impossible to control with conventional interventions. Walter Reed and the U.S. Army Commission solved the mystery of the mode of Yellow Fever transmission. Notably, Reed and his co-workers not only proved the mosquito the vector of transmission but did so by constructing focused research questions leading to cleverly devised experiments that resulted in definitive answers. The results of their research not only proved that the mosquito transmitted the disease, but disproved the other proposed modes of transmission. In nearly all respects Reed's experiments are an excellent paradigm for addressing clinical research questions today.
       
  • SAFMR/SSCI Junior Faculty Research Travel Awards
    • Abstract: Publication date: Available online 30 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Autoimmune thyroid disease in patients with systemic lupus erythematosus:
           a 7-year retrospective study in China
    • Abstract: Publication date: Available online 30 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Shanshan Wei, Zhenghui Yang, Shuangde Xie, Xuebiao Peng, Li Gong, Ke Zhao, Kang Zeng, Kuan Lai BackgroundThe study was a retrospective case-controlled study. We aimed to determine the clinical and laboratory features of systemic lupus erythematosus (SLE) and compared the features of autoimmune thyroid disease (AITD) with those of SLE.MethodsThe study included 38 patients with SLE with AITD (SLE-AITD) and 190 age- and gender-matched SLE patients. The distribution of sociodemographic and clinical factors was compared between the SLE-AITD and SLE groups using Chi-square tests for gender and t tests for others. Univariate and multivariate logistic regression models were used to identify factors associated with the prevalence of AITD among SLE patients.ResultsIn univariate analysis, malar rash, oral ulcers, serositis, anti-double-stranded DNA antibody positivity (anti-dsDNA+), anti-Sjögren's syndrome type A antibodies (SSA), anti-Sjögren's syndrome type B antibodies (SSB), low complement 3 (C3), and low complement 4 (C4) were significantly different between the SLE-AITD and SLE groups. There were no significant differences among other clinical or laboratory features. In multivariate analysis, serositis (adjusted odds ratio [AOR], 3.64; P = 0.00), anti-dsDNA+ (AOR, 0.30; P = 0.01) and low C3 (AOR, 0.30; P = 0.02) were all associated with SLE-AITD.ConclusionsIn our study, serositis was a risk factor for AITD, so we propose that AITD should be considered in lupus patients with serositis.
       
  • Executive Summary
    • Abstract: Publication date: Available online 26 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • HIGHLIGHTS FROM THE 2018 SOUTHERN REGIONAL MEETING
    • Abstract: Publication date: Available online 25 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Expression of cytosolic phospholipase A2 alpha in glioblastoma is
           associated with resistance to chemotherapy
    • Abstract: Publication date: Available online 25 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lei Yang, Haiyan Zhang BackgroundThe clinical management of glioblastoma is still challenging despite aggressive surgery and radio-chemotherapy approaches. Better understanding the molecules involved in glioblastoma chemoresistance is necessary to improve the treatment and predict prognosis.Materials and MethodsWe analyzed the expression and possible roles of cytosolic phospholipase A2 alpha (cPLA2α) in human glioblastoma cell lines and patient samples using immunohistochemistry and cellular assays. We analyzed the signaling pathways that cPLA2α regulates in glioblastoma cells using western blot.ResultsOur work demonstrated that cPLA2α is upregulated in glioblastoma compared with normal neuron cells. The expression of cPLA2α varies in multiple glioblastoma cell lines and is associated with chemoresistance rather than tumor development. cPLA2α depletion moderately inhibits glioblastoma growth and survival but remarkably sensitizes chemo-resistant glioblastoma cells to several chemotherapeutic agents. Mechanistically, cPLA2α knockdown significantly suppresses the PI3K/Akt/mTOR pathway in glioblastoma cells.ConclusionsWe are the first to identify the important role of cPLA2α in glioblastoma in response to chemotherapy. Our data also suggest that cPLA2α may serve as a biomarker to indicate prognosis of glioblastoma patients with high level of cPLA2α to chemotherapy.
       
  • Folliculotropic mycosis fungoides with CD30+ large-cell transformation
    • Abstract: Publication date: Available online 23 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lei Yao, Yan Yu, Yu Guo, Shan-shan Li
       
  • Complete Heart Block in Acute Aortic Dissection: An Unusual Presentation
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Kiran Kumar Gudivada, Ashish Kumar Umesh, Akarsh Reddy Budibetta Sudeendrababu
       
  • Thiamine deficiency: An important consideration in critically ill patients
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Pradeep Attaluri, Austin Castillo, Hawa Edriss, Kenneth Nugent Thiamine is an essential cofactor for 4 enzymes involved in the production of energy (ATP) and the synthesis of essential cellular molecules. The total body stores of thiamine are relatively small, and thiamine deficiency can develop in patients secondary to inadequate nutrition, alcohol use disorders, increased urinary excretion, and acute metabolic stress. Patients with sepsis are frequently thiamine deficient, and patients undergoing surgical procedures can develop thiamine deficiency. This deficiency can cause congestive heart failure, peripheral neuropathy, Wernicke's encephalopathy, Korsakoff's syndrome, and gastrointestinal beriberi. In addition, thiamine deficiency can contribute to the development of intensive care unit complications, such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction, and unexplained lactic acidosis. Consequently, clinicians need to consider thiamine deficiency in patients admitted to intensive care units and the development of thiamine deficiency during the management of critically ill patients. Intravenous thiamine can correct lactic acidosis, improve cardiac function, and treat delirium.
       
  • Efficacy and safety of policosanol plus fenofibrate combination therapy in
           elderly patients with mixed dyslipidemia: a randomized, controlled
           clinical study
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Hai–ya Wang, Qing–ping Jiao, Shu–yan Chen, Jing Sheng, Hua Jiang, Jie Lu, Song-bai Zheng, Ning-yuan FangABSTRACTBackgroundPolicosanol is a mixture of long-chain alcohols isolated from sugar cane. This controlled, randomized clinical trial was designed to compare the efficacy and safety of fenofibrate, policosanol and a combination of these 2 in lowering low-density-lipoprotein cholesterol (LDL-C) in elderly patients with mixed dyslipidemia.MethodsA total of 102 patients aged ≥60 years were randomly assigned into 3 groups: patients receiving a 24-week therapy of fenofibrate (200 mg/day), policosanol (20 mg/day), or fenofibrate + policosanol combination. Lipids were evaluated at baseline, after 16- and 24-weeks of therapy. Brachial-ankle pulse wave velocity (ba-PWV) was performed, and SF-36 questionnaires were used to evaluate the patients’ quality of life. The primary endpoint was the percentage reduction in LDL-C. The secondary endpoints included percentage change in non-high density lipoprotein cholesterol(non-HDL-C), total cholesterol (TC), triglyceride (TG), high-density-lipoprotein cholesterol (HDL-C), ba-PWV and SF-36 scores. Safety was assessed by adverse events and laboratory parameters.ResultsLDL-C, non-HDL-C and TC were decreased respectively after treatment with policosanol for 24 weeks (P
       
  • Sex-based Differences in Heart Failure with Preserved Ejection Fraction
           Reflected by B-type Natriuretic Peptide Level,
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Eisaku Harada, Yuji Mizuno, Fumihito Kugimiya, Makoto Shono, Hiroyuki Maeda, Naotsugu Yano, Hirofumi Yasue BackgroundPrevalence of heart failure with preserved ejection fraction (HFpEF) increases with advancing age, particularly among women. Plasma levels of B-type natriuretic peptide (BNP), a surrogate marker of HF, have consistently been shown to be higher in women in the general populations. Whether BNP levels differ as per the sex of HFpEF patients remains largely unknown.Materials and MethodsThe study subjects were 733 HFpEF patients (204 men and 529 women, aged 80.9 ± 9.6 years) who underwent echocardiography and routine clinical examination, including plasma BNP level evaluation. These parameters were compared between women and men.Results: Plasma levels of BNP were significantly lower in women than in men [104 (61, 192) vs. 133 (78, 255) pg/mL, P < 0.001], just as hemoglobin, atrial fibrillation, diabetes mellitus, beta-blockers, left ventricular diastolic dimension, left ventricular mass index, left ventricular eccentric hypertrophy, and left atrial dimension were. Age, systolic blood pressure, pulse pressure, heart rate, left ventricular relative wall thickness, left ventricular ejection fraction, and left ventricular concentric hypertrophy were higher in women than in men. Multiple regression analyses revealed that left ventricular mass index, body massn index, early diastolic mitral flow velocity/tissue annular motion velocity/left ventricular diastolic dimension, estimated glomerular filtration rate, beta-blockers, left atrial dimensions, female sex, and atrial fibrillation were significant predictors for BNP levels (t = 5.41, P < 0.001, t = -4.06, P < 0.001, t = 3.76, P < 0.001, t = -3.68, P < 0.001, t = 3.32, P = 0.001, t = 3.11, P = 0.002, t = -3.07, P = 0.002, and t = 2.65, P = 0.008, respectively).ConclusionsPlasma BNP levels were lower in women and were related to left ventricular concentric remodeling/hypertrophy among HFpEF patients, contrary to those in the general population.
       
  • Is Dietary Protein Intake Predictive of One-Year Mortality in Dialysis
           Patients',,✰✰✰
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): David P. Murray, Lufei Young, Jennifer Waller, Stephanie Wright, Rhonda Colombo, Stephanie Baer, Vanessa Spearman, Rosalia Garcia-Torres, Kori Williams, Mufaddal Kheda, N. Stanley Nahman BackgroundHigh mortality in dialysis patients may be associated with protein-energy wasting (PEW) syndrome characterized by progressively depleted protein and energy stores. While early diagnosis and treatment of PEW can reduce mortality, clinically practical measures for its detection are lacking. Poor dietary protein intake (DPI) is associated with risk of malnutrition and PEW. However, the impact of DPI on mortality is unclear. The purpose of this study is to examine the ability of DPI to predict 1-year mortality in dialysis patients.MethodsThis prospective, secondary study using data from the Comprehensive Dialysis Study (CDS) and United States Renal Data System examined risk factors associated with 1-year mortality in dialysis patients.ResultsSeventeen (7.5%) of the 227 subjects died within 1 year following baseline data collection. One year survivors were significantly younger (60±13.6 vs. 71±12.8; P = 0.0043), had a lower Charlson Comorbidity Index (CCI) score (1.6±2.3 vs. 4.0±3.6; P = 0.0157), higher serum albumin level (3.5±0.5 vs. 3.3±0.4; P = 0.0173), and had higher DPI (63±33.7 vs. 49.5±21.5 g/day; P = 0.0386) than those who died. In multivariable Cox proportional hazards model analyses, only the CCI adjusted hazard ratio for death (1.24) was significantly associated with increased mortality. The CDS data showed no association between DPI and 1-year mortality in dialysis patients.ConclusionsFuture studies using more precise measures should further examine the impact of DPI on mortality given the known association of DPI with PEW syndrome and the definitive link between PEW syndrome and survival in dialysis patients.
       
  • Complications of Cirrhosis in Primary Care: Recognition and Management of
           Hepatic Encephalopathy
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Steven L. Flamm Approximately 3.7% of patients in primary care settings have chronic liver disease, and 18% with chronic liver disease, in the specialty care setting, have cirrhosis. For cirrhotic patients without complications, prognosis is generally favorable; increased morbidity and mortality are observed when complications (ie, hepatic encephalopathy [HE]) occur. HE occurs in up to 70% of patients with cirrhosis. Neurologic signs in HE span a wide spectrum, from those not easily apparent (covert) to more clinically obvious signs (overt). Providers should consider overt HE in patients with cirrhosis and signs of impaired cognition, confusion, consciousness and/or personality changes, and/or impaired memory. Overt HE treatment includes identifying and treating precipitating factors and reducing bacterial-derived toxin loads. For acute overt HE, lactulose is first-line treatment. To prevent HE recurrence, lactulose plus rifaximin is recommended. Patients with cirrhosis and HE often present in primary care; recognizing and properly managing HE are important in this setting.
       
  • Effect of trimetazidine on preventing contrast-induced acute kidney injury
           in patients with diabetes
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Weidai Zhang, Kefei Wu, Hanfei Lin, Jiawei Zhang, Songming Chen
       
  • "This is a Christian institution and we will tolerate no Jews here": The
           Brooklyn Medical Interns Hazings
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Edward C. Halperin Anti-Semitic quotas to restrict access to medical school, graduate medical education, and hospital privileges were common in the US from the 1920’s to the 1960’s. In Brooklyn, New York, medical education prejudice resulted in violence. In 1916 a Jewish intern at Kings County Hospital (KCH), Matthew Olstein, was bound and gagged by Christian interns, put on a train at Grand Central Station, and warned that if he returned he would be thrown in the East River. Olstein died in combat in World War I as an Army physician. In 1927 three Jewish interns at KCH were assaulted, bound, dumped in tubs of water, and covered in black fluid. Six gentile physicians were charged with assault. Criminal proceedings and public investigations followed. These attacks are the only known episodes of violence associated with American medical education anti-Semitism.
       
  • Sepsis: An update in current practices in diagnosis and management
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Snigdha Jain Despite several advancements in care over the last few decades, sepsis continues to carry a high morbidity and mortality burden in the United States. With its varied presentations, cases of sepsis are likely to be encountered by general practitioners in both inpatient and outpatient settings. In the recent years, there has been much debate about the appropriate criteria to diagnose patients with sepsis with a concurrent change in management guidelines. This article reviews definitions, diagnosis and treatment guidelines in current practice in the management of patients with sepsis.Case presentationA 60-year-old man presented to the emergency department with a 2-day history of chills and dysuria. His medical history was significant for hypertension for which he was taking amlodipine 5 mg daily. Vital signs in the emergency department were significant for a temperature of 38.7°C (101.5°F), heart rate of 120 beats/minute, blood pressure of 90/60 mm Hg, respiratory rate of 20 breaths/ minute, and oxygen saturation of 95% on room air. Physical examination revealed dry mucous membranes, tachycardia without gallops, rubs, or murmurs, clear lungs and warm extremities. Abdominal exam was significant for tenderness on palpation of his suprapubic region. Laboratory testing showed a creatinine level of 1.6 mg/dL (reference range, 0.5 to 1.1 mg/dL) - up from a baseline creatinine of 0.9 mg/dL 4 weeks prior, blood urea nitrogen of 56 mg/dL (reference range, 7 to 20 mg/dL), white-cell count of 18,000/mm3 (reference range, 4500 to 11,000 cells/mm3), hemoglobin of 9.0 g/dL (reference range, 12.0 to 15.5 g/dL) and lactate of 2 mmoL/L (reference range, 0.5-2 mmoL/L). Urinalysis showed 3+ leukocyte esterase,>100 white cells per high-power field, and many bacteria.Does this patient have sepsis' How would you treat him'
       
  • FROM SQUIRRELS TO BIOLOGICAL WEAPONS: THE EARLY HISTORY OF TULAREMIA
    • Abstract: Publication date: Available online 15 June 2018Source: The American Journal of the Medical SciencesAuthor(s): J.V. Hirschmann After George McCoy accidentally discovered a new infection in 1911 while investigating bubonic plague in squirrels, he transmitted the disease to experimental animals and isolated the causative organism. He called it Bacterium tularense, after Tulare County, California. In 1919, Edward Francis determined that an infection called “deer-fly fever” was the same disease, naming it “tularemia.” He demonstrated that it occurred in wild rabbits and inadvertently showed that it was highly infectious, for he and all his laboratory assistants contracted the illness. This characteristic led to studies of its potential as a biological weapon, including involuntary human experimentation by Japan among civilian, political and military prisoners, and its probable use in warfare during World War II. Later, in the United States, voluntary human experimentation occurred in the 1950s-60s with penitentiary inmates and non-combatant soldiers. Soviet Union scientists allegedly developed a vaccine-resistant strain, which they tested as a biological weapon in 1982-3.
       
  • Extensive Calcinosis Cutis in Overlap Syndrome
    • Abstract: Publication date: Available online 13 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Yamen Homsi
       
  • Hematuria and Renal Outcomes in Patients with Diabetic Chronic Kidney
           Disease
    • Abstract: Publication date: Available online 12 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Hugo You-Hsien Lin, Sheng-Wen Niu, I-Ching Kuo, Lee-Moay Lim, Daw-Yang Hwang, Jia-Jung Lee, Shang-Jyh Hwang, Hung-Chun Chen, Chi-Chih Hung BackgroundHematuria may indicate nondiabetic renal disease in diabetic chronic kidney disease (CKD). However, some studies have reported that hematuria is noted in diabetic nephropathy and is associated with albuminuria. Hematuria is a risk factor for end-stage renal disease in glomerulonephritis, but its prognostic value in diabetic CKD is unknown. We investigated the factors associated with hematuria and the prognostic value of hematuria in patients with diabetic CKD.Material and MethodsWe included 1958 patients with type 2 diabetes and CKD stages 1–5, and 111 patients underwent renal biopsy. Patients in the biopsied cohort were younger and had more severe proteinuria, compared with those in the total cohort; hematuria was associated with nondiabetic renal disease.ResultsIn the total cohort, hematuria was observed in 15.0% of the patients and was associated with young age, a lower estimated glomerular filtration rate, proteinuria, high blood pressure, and short diabetes duration. Hematuria was significantly associated with an increased risk (hazard ratio 1.39, 95% CI: 1.10–1.76, P < 0.001) of end-stage renal disease, particularly in patients with CKD stages 1–3 or a urine protein-to-creatinine ratio of
       
  • Sudden Cardiac Arrest in a Young Patient with Severe Pectus
           Excavatum,
    • Abstract: Publication date: Available online 9 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Rayan Jo Rachwan, Andrea K. Purpura, Basil M. Kahwash We report a case of sudden cardiac arrest in the setting of ventricular fibrillation in a previously healthy 19-year-old male. Chest imaging demonstrated severe pectus excavatum with Pectus Severity Index of 22.7. Extensive workup was unrevealing for other cardiopulmonary etiologies, including conduction and structural abnormalities. The patient was scheduled for a Ravitch procedure and was discharged on a wearable defibrillator vest for temporary protection against ventricular arrhythmias. Later, the patient underwent subcutaneous implantable cardioverter defibrillator placement. Sudden cardiac arrest as an initial presentation of pectus excavatum is a rare entity scarcely discussed in medical literature. In this patient-centered focused review, we explore this unique case and offer our management approach amid the lack of concrete guidelines.
       
  • Timing of Left Ventricular Remodeling in Non-ischemic Dilated
           Cardiomyopathy,,✯✯✯
    • Abstract: Publication date: Available online 8 June 2018Source: The American Journal of the Medical SciencesAuthor(s): William S. Bradham, Susan P. Bell, Shi Huang, Frank E. Harrell, Douglas W. Adkisson, Mark A. Lawson, Douglas B. Sawyer, Henry Ooi, Marvin W. KronenbergABSTRACTBackground: Mineralocorticoid receptor antagonist (MRA) treatment produces beneficial left ventricular (LV) remodeling in nonischemic dilated cardiomyopathy (NIDCM). This study addressed the timing of maximal beneficial LV remodeling in NIDCM when adding MRA.Methods: We studied 12 patients with NIDCM on stable beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor-blocking therapy who underwent cardiac magnetic resonance imaging before and after 6-31 months of continuous MRA therapy.Results: At baseline, the LV ejection fraction (LVEF) was 24 (19, 27)% (median, interquartile range). The LV end-systolic volume index (LVESVI) was 63 (57, 76) ml, and the LV stroke volume index (LVSVI) was 19 (14, 21) ml, all depressed. After adding MRA to the HF regimen, the LVEF increased to 47 (42, 52)%, with a decrease in LVESVI to 36 (33, 45) ml, and increase in LVSVI to 36 (28, 39) ml (for each, P 
       
  • The S-Curve Discontinuity Theory Applied to Medicine to Explain
           Healthcare's Past and Predict Its Future
    • Abstract: Publication date: Available online 6 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lisa B.E. Shields, Tyler A. Gertz, Kenneth C. Wilson, Ginger L. Figg, Steven T. Hester, Joshua T. Honaker Developed in 1845 by Verhulst, the logistic growth curve is an “S” shaped sigmoid curve referring to the self-limiting population growth in ecology. The initial growth stage is exponential, followed by slowing of growth as saturation begins, and ending of growth at maturity. In geology, an uncertain period exists at the upper horizontal arm of the S-curve when a species utilizes its available resources, and either extinction or evolution by natural selection results.The S-curve has been used in biology, physics, mathematics, chemistry, economics, sociology, oncology, and statistics. The S-curve theory has been applied to medicine to describe the advancements in the 20th century based on the diagnosis and treatment of disease (the “illness” model) and envision the future focused on disease prevention (the “wellness” model). We expand upon previous S-curve applications in medicine and discuss the obstacles facing the present-day healthcare industry and the numerous advancements that are imminent.
       
  • Hyponatremia complicating esophageal carcinoma: a challenging differential
           diagnosis
    • Abstract: Publication date: Available online 6 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lina Mackelaite, Eleanor Lederer Hyponatremia is a common complication of cancer and of cancer therapy. Awareness of the many causes of hyponatremia in this setting is critical for ordering the appropriate diagnostic tests, instituting the appropriate treatment, and assessing prognosis of the disorder. This case report highlights the challenges in identifying the cause of hyponatremia in some oncology settings and how misdiagnosis can delay appropriate therapy.
       
  • Shiga Toxin as a Potential Trigger of CFHR1 deletion- associated
           Thrombotic Microangiopathy
    • Abstract: Publication date: Available online 5 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Swarna Sri Nalluru, Meera Sridharan, Ronald S. Go, Samar Said, Ariela L. Marshall Thrombotic microangiopathy (TMA) may result from a variety of clinical conditions, including thrombotic thrombocytopenic purpura (TTP), Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS), and complement-mediated hemolytic uremic syndrome (C-HUS). TTP is diagnosed when ADAMTS13 is
       
  • Editorial
    • Abstract: Publication date: Available online 5 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Women's Health in Inflammatory Bowel Disease
    • Abstract: Publication date: Available online 2 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Sai S. Veerisetty, Stephanie O. Eschete, Ann-Porter Uhlhorn, Kara M. De Felice About half of all inflammatory bowel disease (IBD) patients are women. It is important that physicians are aware of gender-specific needs women with IBD may have. This review covers general and specific women's health issues related to their IBD. It is intended to be practical and give a brief overview of topics including body image, menstruation, contraception, cervical cancer screening, preconception counseling, anxiety, depression, pregnancy, breastfeeding, menopause, skin exams, vaccines, laboratory monitoring and bone health.
       
  • An offer we can't refuse: cfDNA as a novel biomarker of myocardial
           infarction
    • Abstract: Publication date: Available online 1 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Daria V. Ilatovskaya, Kristine Y. DeLeon-Pennell
       
  • Tricuspid Regurgitation Pressure Gradient As a Useful Predictor Of Adverse
           Cardiovascular Events And All-cause Mortality In Patients With Atrial
           Fibrillation
    • Abstract: Publication date: Available online 22 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Po-Chao Hsu, Wen-Hsien Lee, Chun-Yuan Chu, Wei-Chung Tsai, Hung-Hao Lee, Chee-Siong Lee, Hsueh-Wei Yen, Tsung-Hsien Lin, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu, Ho-Ming Su BackgroundTricuspid regurgitation pressure gradient (TRPG) is reportedly a predictor of cardiovascular mortality in patients without atrial fibrillation (AF); its relationship with cardiac outcomes in patients with AF has never been evaluated. This study aimed to examine the ability of TRPG for predicting CV events and all-cause mortality in patients with AF.Materials and MethodsComprehensive echocardiography was performed in 155 patients with persistent AF. Combined cardiovascular events were defined as cardiovascular mortality, stroke, and hospitalization for heart failure.ResultsDuring an average follow-up period of 27 months, 57 cardiovascular events and 31 all-cause deaths occurred. According to multivariate analysis, predictors of cardiovascular events included diuretic use, decreased left ventricular ejection fraction (LVEF), increased ratio of transmitral E velocity (E) to early diastolic mitral annular velocity (E′), and TRPG. Predictors of all-cause mortality included old age, decreased LVEF, increased E/E′, and TRPG. Notably, the addition of TRPG to a model containing clinical significant parameters, LVEF, and E/E′ significantly improved the values in predicting adverse cardiovascular events and all-cause mortality.ConclusionsThe TRPG is not only a useful predictor of adverse cardiovascular events and all-cause mortality in patients with AF, it may also provide additional prognostic values for cardiovascular outcome and all-cause mortality over conventional parameters in such patients.
       
  • The Summer Enrichment Program: A Multidimensional Experiential Enriching
           Experience for Junior Medical Students
    • Abstract: Publication date: Available online 16 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Abdulhadi A. AlAmodi, Ahmed Abu-Zaid, Abdulaziz M. Eshaq, Khaled Al-Kattan
       
  • Variation in high-intensity statin use after hospitalization for acute
           vascular emergencies
    • Abstract: Publication date: Available online 16 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Anusha Shanbhag, Aneesha Ananthula, Raga Deepak Reddy Palagiri, Richa Parikh, Raghunandan Purushothaman, Srikanth Vallurupalli
       
  • 1 &rft.title=American+Journal+of+the+Medical+Sciences&rft.issn=0002-9629&rft.date=&rft.volume=">Experiential Learning in Medical Education 1
    • Abstract: Publication date: Available online 3 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Urvashi Vaid
       
  • Hepatitis B virus infection is independently associated with advanced
           colorectal adenoma
    • Abstract: Publication date: Available online 2 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Su Hwan Kim, Ji Won Kim, Kook Lae Lee, Seohui Lee, Seong-Joon Koh, Ji Bong Jeong, Byeong Gwan Kim IntroductionStudies on the association of chronic hepatitis B virus (HBV) infection with colonic neoplasm are rare. We aimed to investigate the association between chronic HBV infection and the development of colonic adenoma.Materials and MethodsOne hundred thirty-three patients with chronic HBV infection, who underwent colonoscopic examination, were enrolled. A healthy HBV-uninfected group was matched with the HBV group. Those with a previous history of colorectal cancer, inflammatory bowel diseases, or colorectal surgery were excluded from both HBV and HBV-uninfected groups. Clinical information and data on age, sex, body mass index, smoking, alcohol consumption, and comorbidities were obtained. Advanced adenoma was defined as tubular adenoma ≥ 10 mm, or adenoma with a villous component or high-grade dysplasia.ResultsThe HBV group had a higher rate of colorectal adenoma and advanced adenoma than the HBV-uninfected group. Patients in the HBV group had larger colorectal polyps than those in the HBV-uninfected group. In the chi square test, HBV DNA positivity was significantly associated with colorectal adenoma (P < 0.001) and advanced adenoma (P = 0.007). HBV infection (odds ratio [OR] 23.961, 95% CI 9.400–61.076), diabetes mellitus (OR 2.633, 95% CI 1.071–6.473), and age (OR 1.057, 95% CI 1.020–1.095) were significantly associated with advanced adenoma in the multivariable logistic regression analysis. Multivariable logistic regression analysis within the HBV group revealed that HBV DNA (OR 1.236, 95% CI 1.029–1.485) was associated with advanced adenoma.ConclusionsHBV DNA in patients with HBV infection and HBV infection are independently associated with advanced colorectal adenoma development.
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 54.198.212.30
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-