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  Subjects -> MEDICAL SCIENCES (Total: 7854 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (196 journals)
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    - MEDICAL SCIENCES (2040 journals)
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    - RHEUMATOLOGY (67 journals)
    - SPORTS MEDICINE (74 journals)
    - SURGERY (374 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (141 journals)

MEDICAL SCIENCES (2040 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: 42)
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: 8)
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: 3)
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: 11)
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)
Althea Medical Journal     Open Access  
American Journal of Biomedical Engineering     Open Access   (Followers: 13)
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: 47)
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: 17)
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 Health Research     Open Access  
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 Rehabilitation Medicine     Open Access  
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: 17)
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 Informatics     Hybrid Journal   (Followers: 2)
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   (Followers: 1)
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: 14)
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: 10)
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: 4)

        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  [3160 journals]
  • Several routes to the same destination: inhibition of phagosome-lysosome
           fusion by Mycobacterium tuberculosis
    • Abstract: Publication date: Available online 8 December 2018Source: The American Journal of the Medical SciencesAuthor(s): Claudia Carranza, Leslie Chavez-Galan Phagocytosis is necessary for antigen degradation and presentation, the activation of the adaptive immune response and the elimination of pathogenic microorganisms. The phagosomal vacuole formed during phagocytosis requires a process of maturation that involves fusion with lysosomes, a decrease in luminal pH and the activation of the enzymes that eventually will destroy phagocytized microorganisms. Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. This agent has developed various strategies to prevent phagosome maturation and persist indefinitely in latency mode. Herein, we review these strategies in the light of available experimental evidence. A better understanding of them may be essential in the development of more effective therapies against tuberculosis.
       
  • Serum peroxisome proliferator-activated receptor gamma coactivator-1α
           related to myocardial energy expenditure in patients with chronic heart
           failure
    • Abstract: Publication date: Available online 7 December 2018Source: The American Journal of the Medical SciencesAuthor(s): Pingan Chen, Qiong Zhan, Yujia Bai, Xingfu Huang, Peng Wang, Yizhi Pan, Shaonan Li, Shenshen Fu, Wenyan Lai, Qingchun Zeng, Hao Ren, Dingli Xu BackgroundPeroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) plays key roles in controlling cardiac metabolism and function. Myocardial energy expenditure (MEE) can reflect myocardial energy metabolism and cardiac function. Whether the variation of PGC-1α can influence MEE levels in chronic heart failure (CHF) is unclear. Therefore, we investigated the relationship between PGC-1α and MEE.MethodsTwo hundred and nineteen patients with CHF and 66 healthy controls were studied. MEE was measured according to echocardiographic parameters. Serum PGC-1α, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and other parameters were detected. Patients with CHF were divided into different groups according to the left ventricular ejection fraction (LVEF) and the tertile range of MEE, respectively.ResultsSerum PGC-1α was lower in the MEE 2 and 3 groups in patient groups compared with controls (both P < 0.05). Patients in the MEE 2 (1.73±0.83 versus 2.16±0.82 ng/ml, P = 0.001) and 3 groups (1.65±0.73 versus 2.16±0.82 ng/ml, P < 0.001) possessed lower levels of PGC-1α than those in the MEE 1 group. Compared with high LVEF, patients with low LVEF had higher MEE (median, 167 versus 73 cal/minute, P < 0.05) and lower PGC-1α (1.71±0.65 versus 1.95±0.91 ng/ml, P = 0.032). Multivariate logistic regression analysis showed that MEE (OR =0.517, 95% CI =0.267 to 0.998, P = 0.049) and creatinine (OR =2.704, 95% CI =1.144 to 6.391, P = 0.023) were independently associated with increased PGC-1α.ConclusionsSerum PGC-1α was related to MEE and LVEF in patients with CHF and can reflect the degree of MEE and the systolic function of the left ventricle.
       
  • Allopurinol induced Steven Johnson Syndrome
    • Abstract: Publication date: Available online 4 December 2018Source: The American Journal of the Medical SciencesAuthor(s): Sushilkumar Satish Gupta, Nitin Sabharwal, Ravikaran Patti, Yizhak KupferABSTRACTAllopurinol is a first line agent in treating gout, but it also carries the risk of severe side effects. Stevens-Johnson syndrome (SJS) is one of the life threatening severe cutaneous adverse reactions (SCARs) caused by allopurinol. The severity of the SCARs can be categorized based upon the area of skin involvement: (1) Erythema multiforme major limited to 1-2 % of the body surface area (BSA); (2) SJS involving 30% of the BSA. SJS can be caused by drugs and viruses, the former being more frequent. We report a case of an 85-year-old Han-Chinese female who developed SJS after ingestion of allopurinol 8 days prior to the hospitalization. The patient also had concomitant acute viral illness, which complicated the clinical scenario causing acute renal failure and hemodynamic compromise.
       
  • The role of plasmapheresis in treating lethal cupric sulfate poisoning
    • Abstract: Publication date: Available online 29 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Yu Du, Yi Mou The mortality rate of cupric sulfate is relatively high in contrast to that of other heavy metals. Cases of orally ingested cupric sulfate poisoning are very rare, with a reported half lethal dose of 10 g. Cupric sulfate poisoning leads to gastrointestinal corrosion, intravascular hemolysis, hemolytic anemia, methemoglobinemia, and acute renal and hepatic impairment. Without proper and prompt treatment, multiple organ failure and death occur. Here, we present the first report that removal of the excessive intravascular copper ions by plasmapheresis was accompanied by complete recovery.
       
  • Managing Implantable Cardioverter-Defibrillators at End of Life: Practical
           Challenges and Care Considerations
    • Abstract: Publication date: Available online 29 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Rohan Khera, Ambarish Pandey, Mark S. Link, Melanie S. SulistioABSTRACTImplantable cardioverter-defibrillators (ICDs) monitor for and terminate malignant arrhythmias. Given their potential as a life-saving therapy, an increasing number of people receive an ICD every year, and a growing number are currently living with ICDs. However, cardiopulmonary arrest serves as the final common pathway of natural death, and the appropriate management of an ICD near the end-of-life is crucial to ensure that a patient's death is not marked by further suffering due to ICD shocks. The tenets of palliative care at the end-of-life include addressing any medical intervention that may preclude dying with dignity; thus management of ICDs during this phase is necessary. Internists are at the forefront of discussions about end of life care, and are likely to find discussions about ICD care at the end-of-life particularly challenging. The present review addresses issues pertaining to ICDs near the end of a patient's life and their potential impact on dying patients and their families. A multi-disciplinary, patient-centered approach can ensure that patients receive the maximum benefit from ICDs, without any unintended pain or suffering.
       
  • Hepatotoxicity and recurrent NSTEMI while on Pembrolizumab for metastatic
           Giant Cell Bone Tumor
    • Abstract: Publication date: Available online 29 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Jennifer M Kwan, Renee Cheng, Lawrence Feldman We present the first reported case showing metastatic giant bone cell tumor being treated successfully with pembrolizumab after failing prior tyrosine kinase inhibitor therapy. Of note, the patient developed multiple systemic effects associated with checkpoint inhibitor use. One year after starting the checkpoint inhibitor (ICI), the patient also developed hepatitis that was confirmed by liver biopsy and pathology to be, in part, due to drug-mediated toxicity similar to prior ICI toxicity cases that have been reported. Additionally, although the patient had vascular risk factors (hypertension, diabetes, smoking), it was notable from a cardiology perspective that the patient developed 2 subsequent non-ST-elevation myocardial infarctions, with rapid progression of stenosis of the left circumflex artery 2 months apart. The first left heart catheterization (LHC) showing minimal disease of the left circumflex, but 2 months later, presenting with chest pain, a repeat LHC showed significant stenosis of the left proximal circumflex, raising the possibilities that either ICI can promote plaque rupture and/or accelerated atherosclerosis; both phenomena have been shown to occur in animal models. The patient also developed thyroiditis with subsequent hypothyroidism, now on thyroid replacement from checkpoint inhibitor use. This case demonstrates the multi-organ adverse effects this new anti-oncologic agent can have and yet also its promising anti-tumor effects. Awareness of the side effects amongst primary care doctors and all specialists will be helpful in managing these potential side effects and research will help elucidate ways to prevent the adverse effects.
       
  • High visceral adipose tissue to subcutaneous adipose tissue ratio as a
           predictor of mortality in acute respiratory distress syndrome
    • Abstract: Publication date: Available online 29 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Yue-Nan Ni, He Yu, Hui Xu, Wei-jing Li, Bin-miao Liang, Ling Yang, Zong-An LiangABSTRACTBackgroundWe aimed to further determine the relationship between the areas of visceral adipose tissue to subcutaneous adipose tissue (VAT/SAT), SAT, VAT and the outcomes of acute respiratory distress syndrome (ARDS) patients.MethodsA retrospective study was performed on patients with ARDS in 7 intensive care units (ICU) of West China Hospital, Sichuan University.ResultsA total of 169 patients were included in the analysis. Abdominal computed tomography (CT) scans of each patient within 24 hours of being admitted to the ICU were assessed by at least 2 investigators. Higher VAT/SAT was related with higher hospital mortality (22% vs. 44%, P = 0.003; adjusted odds ratio [aOR] 0.699, 95% confidence interval [CI] 0.530-0.922 (P = 0.011]). On the contrary, higher SAT and VAT was related with lower hospital mortality in ARDS (aOR 1.077, 95% CI 1.037-1.119 [P
       
  • Emphysematous Gut
    • Abstract: Publication date: Available online 29 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Raghav Bansal, Uday Shankar, Aaron Walfish
       
  • Correlation of intestinal mucosal healing and tight junction protein
           expression in ulcerative colitis patients
    • Abstract: Publication date: Available online 27 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Yue Tan, Yadi Guan, Yan Sun, Changqing Zheng BackgroundThe aim of this study was to investigate the relationship between intestinal mucosal healing and tight junction (TJ) protein expression in patients with ulcerative colitis (UC).MethodsA total of 40 patients with UC were included as an experimental group and UC disease activity was evaluated using the Mayo clinic score (MCS) and 8 patients with normal distal colon served as the control group. The expression of TJ proteins including occludin, ZO-1 and claudin-2 were determined by immunohistochemistry and thier correlation with clinical characteristics were also analyzed.ResultsStatistically significant differences regarding the MCS and Mayo endoscopic subscore (MES) were observed in both groups (P < 0.01). The Geboes index was significantly increased in patients with active UC compared to patients with quiescent UC and normal controls (P < 0.01). Patients with active and quiescent UC had upregulated expression of claudin-2 and reduced expression of occludin and ZO-1 compared to those of normal controls. The expression of ZO-1 was significantly higher in patients with quiescent UC with mucosa healing (P < 0.05) compared with those without mucosal healing. The expression of ZO-1 and occludin was negatively correlated with MCS, MES, Geboes, C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR). The expression of claudin-2 was positively correlated with MCS, MES, Geboes, CRP and ESR.ConclusionsThese finding suggest that TJ proteins play a crucial role in mucosal healing, and may be a potential marker of response when evaluating therapeutic interventions.
       
  • In Vivo and In Vitro Effects of Vasopressin V2 Receptor Antagonism on
           Myocardial Fibrosis in Rats
    • Abstract: Publication date: Available online 24 November 2018Source: The American Journal of the Medical SciencesAuthor(s): LiangLiang Zhang, Lija Joseph, Jacob Joseph BackgroundMyocardial fibrosis is a major pathophysiologic substrate of heart failure with preserved ejection fraction (HFpEF). Vasopressin is an important therapeutic target in HFpEF since it can modulate fluid balance, and based on a few studies, myocardial matrix deposition. Hence we examined the role of vasopressin antagonism in modulating myocardial matrix metabolism in vivo and in vitro.MethodsIn vivo studies utilized an established model of hyperhomocysteinemia-induced myocardial fibrosis in Sprague-Dawley rats combined with high salt diet; in vivo studies also utilized the same pro-fibrotic stimuli of homocysteine and NaCl in cultured rat cardiac fibroblasts.ResultsHyperhomocysteinemia combined with high salt diet promoted myocardial fibrosis, pro-fibrotic and matrix gene expression, and tolvaptan attenuated all these in vivo effects. In cultured cardiac fibroblasts, combined treatment with homocysteine and NaCl increased pro-fibrotic and matrix gene expression and activation of PI3/Akt pathway; all these effects were attenuated by tolvaptan. Vasopressin levels, gene expression and V2 receptor expression were increased in vivo and in vitro on exposure to pro-fibrotic stimuli, and tolvaptan attenuated these in vivo and in vitro effects.ConclusionsAntagonism of vasopressin V2 receptor, via direct actions on cardiac fibroblast, attenuates myocardial matrix deposition.
       
  • Long noncoding RNA ANRIL correlates with risk, severity, inflammation and
           infliximab efficacy in Crohn's disease
    • Abstract: Publication date: Available online 22 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Qiongxiang Ge, Yuan Dong, Guoqiang Lin, Yi CaoABSTRACTBackgroundThe aim of this study was to investigate the association of intestinal mucosa long noncoding RNA (lncRNA) ANRIL expression with disease risk, activity and inflammatory cytokines levels of Crohn's disease (CD).MethodsForty-two active CD patients (A-CD patients), 59 CD patients in remission (R-CD patients) and 67 controls were consecutively recruited. Intestinal mucosa samples from all participants at baseline and from A-CD patients at 3-month after infliximab treatment were collected. LncRNA ANRIL level, mRNAs expressions of tumor necrosis factor-α (TNF-α), interleukin (IL)-10, IL-17, IL-23 and interferon gamma (IFN-γ) were assessed by quantitative polymerase chain reaction (qPCR). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Crohn's disease activity index (CDAI) were used to evaluate the disease activity of CD.ResultsLncRNA ANRIL expression was decreased in A-CD patients compared with R-CD patients (P < 0.001) and controls (P < 0.001) and was also reduced in R-CD patients compared with controls (P < 0.001). Receiver operating characteristic (ROC) curves showed that lncRNA ANRIL expression distinguished CD, A-CD and R-CD patients from controls, as well as A-CD patients from R-CD patients. Additionally, lncRNA ANRIL expression was negatively associated with CDAI (P = 0.002), CRP (P < 0.001), and ESR (P = 0.001), and also associated with TNF-α (P < 0.001), IL-17 (P < 0.001) and IFN-γ messenger RNA levels (P = 0.004) but positively associated with IL-10 messenger RNA level (P = 0.002). Furthermore, IncRNA ANRIL expression was increased after infliximab treatment compared with baseline in response A-CD patients (P < 0.001) but remained stable in non-response A-CD patients (P = 0.897).ConclusionslncRNA ANRIL downregulation in intestinal mucosa correlates with increased disease risk, higher disease activity and elevated pro-inflammatory cytokines levels, and its change associates with infliximab treatment response in CD patients.
       
  • Epidemiology of Sarcopenia and Factors Associated with It among
           Community-Dwelling Older Adults in Taiwan
    • Abstract: Publication date: Available online 22 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Yun-Hua Kuo, Tze-Fang Wang, Li-Kuo Liu, Wei-Ju Lee, Li-Ning Peng, Liang-Kung Chen BackgroundSarcopenia is a well-recognized geriatric syndrome. We sought to determine the prevalence of sarcopenia and factors associated with it among community-dwelling older adults in Taiwan.MethodsA cross-sectional study was conducted in Yuanshan Township, Yilan County, Taiwan. Data of 731 community-dwelling adults aged 65 and older were evaluated. Demographic characteristics, anthropometry, medical history, biochemistry results, and dual-energy X-ray absorptiometry results were collected for analysis.ResultsMales had a higher rate of sarcopenia than did females and had lower values for body weight, body mass index, waist circumference, percentage of body fat, and lean body mass. Poor nutritional status as determined by the Mini Nutritional Assessment correlated positively with markers for sarcopenia. Levels of vitamin D and folic acid correlated positively with some sarcopenia markers.ConclusionsGender differences and nutritional factors may influence the development of sarcopenia. Vitamin D is positively correlated with RASM in males with sarcopenia, and folic acid was positively correlated with gait speed in females with sarcopenia.
       
  • Body adiposity index and body roundness index in identifying insulin
           resistance among adults without diabetes
    • Abstract: Publication date: Available online 22 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Jiayue Feng, Sen He, Xiaoping Chen BackgroundBody adiposity index (BAI) and body roundness index (BRI), initially developed to assess obesity, were evaluated here to detect insulin resistance in comparison with traditional anthropometric indices of body mass index (BMI), waist circumference (WC), weight-to-height ratio (WHtR), visceral adiposity index (VAI) and abdominal volume index (AVI).Methods and ResultsIn this cross-sectional study, 570 Chinese individuals without diabetes were evaluated. The Spearman rank test showed that insulin resistance correlated most strongly with WC and AVI in men and BMI in women, and most weakly with BAI in men and VAI in women. The prevalence of insulin resistance increased per quartile for all 7 anthropometric indices. Multivariate logistic regression identified BAI as the weakest predictor of insulin resistance in both genders (men, odds ratio [OR] 3.34, 95% CI 1.09-10.18; women, OR 4.90, 95% CI 1.89-12.69), AVI as the strongest predictor in men (OR 19.73, 95% CI 2.51-155.04) and BMI as the strongest predictor in women (OR 15.55, 95% CI 4.71-51.28). The area under the receiver operating characteristic curve (AUC) showed that BAI exhibited the lowest AUCs for men (0.653, 95% CI 0.574-0.731) and women (0.701, 95% CI 0.627-0.774). BRI showed significantly higher AUCs for men (0.769, 95% CI 0.699-0.838) and women (0.763, 95% CI 0.699-0.827), and WHtR showed equal AUCs to BRI.ConclusionsNeither BAI nor BRI were superior to BMI, WC, WHtR, VAI or AVI for predicting insulin resistance. BAI showed the weakest predictive ability, while BRI showed reasonable potential to serve as an alternative anthropometric index to detect insulin resistance.
       
  • Sinonasal and laryngeal sarcoidosis-an uncommon presentation and
           management challenge
    • Abstract: Publication date: Available online 22 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Hawa Edriss, John S Kelley, Joshua Demke, Kenneth Nugent Sarcoidosis is a chronic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas. The thorax is involved in 95% of cases, but any organ can be involved. Sinonasal or laryngeal involvement is uncommon and can be difficult to diagnose. The reported incidence of sarcoidosis in the upper airway clearly depends on study characteristics, and this creates uncertainty about the actual incidence. In a large prospective study in the United States upper respiratory tract involvement occurred in 3% of the patients. Some patients have upper airway involvement without thoracic disease, and this presentation may cause delays in diagnosis. These patients have nonspecific symptoms which range from minimal nasal stuffiness to life-threatening upper airway obstruction. Currently there is no established standard therapy for the management of upper airway sarcoidosis. These patients often respond poorly to nasal and/or inhaled corticosteroids and require long courses of oral corticosteroids. Patients with poor responses to oral corticosteroids or severe side effects may respond to tumor necrosis factor alpha inhibitors. In this review we will discuss the clinical presentation, pathogenesis, diagnostic tests, drug treatment, surgical management options, and the challenges clinicians have managing these patients.
       
  • Tumor necrosis factor receptor type 1-associated death domain protein is a
           potential prognostic biomarker in acute myeloid leukemia
    • Abstract: Publication date: Available online 20 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Yi Xiao, Zhe Geng, Taoran Deng, Di Wang, Lijun Jiang BackgroundTumor necrosis factor receptor type 1-associated death domain protein (TRADD) mediates programmed cell death signaling as well as the Fas-induced cell death pathway. The downregulation of TRADD is found to be associated with the occurrence of many cancers. The present study was designed to investigate the association between TRADD and clinicopathologic features as well as its clinical significance in acute myeloid leukemia (AML).MethodsReal-time polymerase chain reaction was performed in 100 new AML, 23 AML complete remission patients and 20 normal individuals. All statistical analysis was performed using SPSS software.ResultsIt was found that the expression of TRADD messenger RNA (mRNA) was lower in new AML patients as compared to healthy individuals and complete remission patients (P = 0.00239). Moreover, TRADD mRNA levels were associated with clinical factors such as risk classification (P = 0.0023) and complete remission (P = 0.0147). Kaplan–Meier analysis revealed that the AML patients with high TRADD expression had significantly prolonged overall survival and higher complete remission compared with low TRADD expressing patients.ConclusionsIt is concluded that downregulation of TRADD may be an independent potential prognostic biomarker in AML.
       
  • Acknowledgment of Reviewers
    • Abstract: Publication date: December 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 6Author(s):
       
  • Dystrophic Calcifications in Chronic Venous Insufficiency
    • Abstract: Publication date: Available online 14 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Rukma Govindu
       
  • Changes in fecal calprotectin after rifaximin treatment in patients with
           non-constipated irritable bowel syndrome
    • Abstract: Publication date: Available online 13 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Seok-Hoon Lee, Cho-Rong Kim, Kyu-Nam Kim BackgroundFecal calprotectin, an indicator of colonic inflammation, is associated with non-constipated irritable bowel syndrome. Rifaximin is an antibiotic used to treat non-constipated irritable bowel syndrome. We performed a retrospective review of patient charts to investigate the changes in fecal calprotectin levels and intestinal symptoms following treatment with rifaximin in patients with non-constipated irritable bowel syndrome with elevated fecal calprotectin.MethodsThis study included 198 patients presenting with gastrointestinal complaints consistent with Rome III criteria for irritable bowel syndrome. We treated them with rifaximin for 4 - 12 weeks, until fecal calprotectin levels were normalized, and divided these into 4-, 8-, and 12-week groups according to the treatment period. Fecal calprotectin levels and gastrointestinal symptoms were assessed following rifaximin therapy.ResultsA total of 162 subjects achieved normalized fecal calprotectin values. Of these, most patients who used rifaximin for 8 or 12 weeks showed a significant improvement in gastrointestinal symptoms by the fourth week of treatment, and gradually improved symptoms after 4 weeks. Fecal calprotectin levels were reduced with concomitant improvement of clinical symptoms. In addition, 36 patients who had elevated fecal calprotectin even after 12 weeks of rifaximin treatment showed a gradual reduction in gastrointestinal symptoms and fecal calprotectin during the course of treatment for 12 weeks.ConclusionsThese findings suggest that fecal calprotectin might be a useful biomarker for measuring the effect of rifaximin therapy in non-constipated irritable bowel syndrome patients with elevated fecal calprotectin values.
       
  • Coronary Artery Embolism: Two Case Reports and a Review of the Literature
    • Abstract: Publication date: Available online 10 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Philip S. Vendittelli, Bassent Botros, Howard S. Rosman, Viren Govindaraju, Anwar Zaitoun, Tariq S. Marroush Coronary embolism (CE) is an uncommon and unique cause of acute myocardial infarction. In this report, we review 216 cases of CE including 2 new cases from our institution. The mean patient age was 52.5 years and 62% of the patients were males. Chest pain was the most common presenting symptom followed by dyspnea, and the most commonly affected vessel was the left anterior descending artery. Leading etiologies of the embolus were atrial fibrillation, septic emboli and iatrogenic causes. Treatment approaches varied with thrombus aspiration being used in 30% of cases. In-hospital mortality rate was 36% and 13% of the cases were complicated by cerebrovascular accident. CE is a unique pathology that leads to acute myocardial infarction. It portends a high mortality rate and requires a high level of suspicion as symptoms may be misleading. Further research is needed in order to improve recognition and management and to lower associated mortality.
       
  • Case Report: Can a high-grade neuroendocrine carcinoma be functional'
    • Abstract: Publication date: Available online 10 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Christopher Graham, Aman Chauhan, Lowell AnthonyABSTRACTWe present a rare high-grade, functional, neuroendocrine carcinoma of the pancreas secreting vasoactive intestinal peptide (VIP). This case is unique given the tumor's aggressive features and high Ki-67 index while also secreting functional hormones, which is unusual in high-grade neuroendocrine tumors. Our patient initially presented with diarrhea and was found to have a 4.7 × 3.1 × 3.3cm pancreatic mass with diffuse hepatic metastasis staining positive for VIP, chromogranin A and synaptophysin. She was initially underscored as Grade 2 neuroendocrine tumor due to low mitosis, but subsequently restaged based on Ki-67 index as a Grade 3 neuroendocrine carcinoma. She unfortunately was not a candidate of chemotherapy at that time. We conclude that high-grade neuroendocrine tumors have the potential to secrete active peptide hormones. We therefore recommend that neuroendocrine tumors with aggressive features be biopsied and assessed for Ki-67 activity and mitosis regardless if they are functional tumors, with goal for early initiation of chemotherapy.
       
  • Pseudocholinesterase Deficiency: What the gastroenterologist needs to know
    • Abstract: Publication date: Available online 10 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Alejandro Robles, Majd Michael, Richard McCallumABSTRACTPseudocholinesterase deficiency is a rare genetic as well as an acquired disorder that affects the body's ability to metabolize choline esters such as succinylcholine and mivacurium. It can be inherited as an autosomal recessive trait, occurring in approximately 1 in 3,200 to 1 in 5,000 people. In most cases of pseudocholinesterase deficiency, no signs or symptoms of the condition exists. It is first suspected after a prolonged recovery from paralysis following general anesthesia in which succinylcholine or mivacurium are administered. We emphasize the importance of obtaining a detailed history prior to any endoscopic intervention or surgery requiring monitored anesthesia care or general anesthesia. In addition, a family history of anesthesia complications may help identify patients at risk. This article examines a case of a patient who underwent a successful endoscopic pneumatic dilation under general anesthesia for the treatment of achalasia but was subsequently admitted to the intensive care unit, requiring mechanical ventilator support, for 18 hours. The patient made a complete recovery and was subsequently discharged home with no further complications. This case stimulated a review of this entity and we provide recommendations relevant to all proceduralist and anesthesia staff, as well as all personnel involved in procedures.
       
  • Transplantation of endothelial progenitor cells attenuates
           lipopolysaccharide-induced lung injury via inhibiting the inflammatory
           secretion of neutrophils in rats
    • Abstract: Publication date: Available online 2 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Mei Mao, Lei Hao, Yi Wang, Qiu-qian LiuABSTRACTBackgroundEndothelial progenitor cells (EPCs) are special types of stem cells and are a potential novel therapeutic approach in acute lung injury (ALI). Transplantation of EPCs can ameliorate the inflammatory state by reducing adhesion and exudation of inflammatory cells. However, the mechanism underlying the effect of EPCs on inflammatory response modulation remains unclear. The aim of the present study was to investigate the effect of EPCs on the modulation of neutrophils in vitro and in vivo.MethodsEPCs were cocultured with neutrophils after lipopolysaccharide stimulation in vitro or transplanted into ALI rats, and neutrophil inflammatory mediators including tumor necrosis factor-α, interleukin-1β, neutrophil elastase, myeloperoxidase, and matrix metalloproteinases-9 were detected by enzyme-linked immunosorbent assay (ELISAs), an myeloperoxidase detection kits, reverse transcription-polymerase chain reaction (RT-PCR) and western blotting.ResultsThe results showed that EPCs significantly downregulated the expression of inflammatory mediators when cocultured with neutrophils in vitro or in vivo.ConclusionsThese findings demonstrated that EPCs contributed to lung injury in ALI rats by downregulating neutrophil inflammatory mediators.
       
  • Iron Deficiency Anemia Associated with Acid-Modifying Medications: Two
           Cases and Literature Review
    • Abstract: Publication date: Available online 1 November 2018Source: The American Journal of the Medical SciencesAuthor(s): Ramya Deepthi Vinnakota, Allan S. Brett Iron deficiency anemia is often listed among potential adverse effects of gastric acid-suppressive medications, given that gastric acidity promotes intestinal absorption of non-heme iron. Additionally, the antacid calcium carbonate can inhibit iron absorption. However, there is little direct clinical evidence that proton-pump inhibitors, histamine-2 receptor antagonists, or calcium carbonate cause iron deficiency anemia. Most case reports have had substantial limitations (e.g., minimal follow-up and presence of other causes of iron deficiency), and retrospective cohort studies have lacked sufficient patient-specific detail to make strong causal inferences. We present two cases – both with detailed, prospective 10-year follow-up – in which combinations of proton-pump inhibitors, histamine-2 receptor antagonists and calcium carbonate were clearly associated with development of iron deficiency anemia. Overt iron-deficiency anemia is probably uncommon in patients who use acid-modifying medications and who have no other conditions that predispose to iron deficiency. Nevertheless, clinicians should be aware of this potential complication, given widespread use of these agents.
       
  • Complete Heart Block from Chronic Marijuana Use: A Word of Caution Against
           Medical Marijuana
    • Abstract: Publication date: Available online 30 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Priyam Mithawala, Priyank Shah, Edward KoomsonABSTRACTMarijuana is the most commonly used illicit drug in the world. Over the last decade, the potency of marijuana has increased tremendously. Its use is associated with harmful health consequences including adverse cardiovascular effects, such as arrhythmias, myocardial infarction, cardiomyopathy, and stroke. It has been reported to cause bradycardia. This report describes the case of a 51-year-old female with no significant past medical history who presented with complete heart block due to chronic marijuana use, requiring a permanent pacemaker. To our knowledge, this is the first reported case of complete heart block due to chronic marijuana use. Advanced conduction system abnormalities can be a potential complication of chronic marijuana use, which the physicians need to be aware of. With increasing push for medical marijuana, physicians are likely to encounter more of such cases.
       
  • Preoperative serum 25-hydroxyvitamin D level, a risk factor for
           postoperative cognitive dysfunction in elderly subjects undergoing total
           joint arthroplasty
    • Abstract: Publication date: Available online 30 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Bin Gao, Binbin Zhu, Chunxian Wu BackgroundPostoperative cognitive dysfunction (POCD) is a very common postoperative complication occurring mainly after high-risk surgery, especially in the elderly individuals. This study aimed to investigate potential risk factors for POCD in elderly patients after total joint arthroplasty (TJA).MethodsA total of 257 eligible elderly patients (≥65 years) who were scheduled for elective TJA for osteoarthritis with general anesthesia were enrolled. An experienced psychiatrist was invited to evaluate the cognitive function at baseline (1 day before the surgery) and at day 7 after the surgery. Univariate and multiple logistic regression analyses were performed to screen risk factors associated with POCD. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of serum 25-hydroxyvitamin D (25(OH)D) expression for POCD.ResultsOf all the 257 enrolled patients, 55 (21.4%) developed POCD within 7 days after the surgery. Serum 25(OH)D level was the only independent risk factor associated with POCD (odds ratio [OR]: 1.77, 95% CI: 1.13-2.78, P = 0.016) by multiple logistic regression analysis. The area under the curve (AUC) of 25(OH)D for POCD was 0.687, with the cut-off value of 11.2ng/mL, sensitivity of 41.82% and specificity of 78.71% respectively (95% CI: 0.617-0.757, P < 0.001).ConclusionsOur results revealed that preoperative serum 25(OH)D level was an independent risk factor for POCD in elderly subjects after TJA.
       
  • 5-(3,3-Dimethyle-1-Triazeno) Imidazole-4-Carboxamide (DTIC) and
           Interleukin-2 Adjuvant Therapy in Resected High-Risk Primary and
           Regionally Metastatic Melanoma
    • Abstract: Publication date: Available online 25 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Amitoj Gill, Rahul Gosain, Hana Gragg, Ryan Bycroft, Shesh N. Rai, Jianmin Pan, Jason A. Chesney, Donald M. MillerBackgroundIn the pre-checkpoint inhibitor era, high-dose interferon (HDI) was the only approved adjuvant therapy for high-risk melanoma. In this manuscript, we analyze the recurrence free survival(RFS), overall survival(OS), and toxicity profile of adjuvant treatment with Interleukin-2(IL-2) and 5-(3,3-Dimethyle-1-Triazeno) Imidazole-4-Carboxamide(DTIC) for resected high-risk melanoma patients.Patients and MethodsAll patients with stage IIB, IIC or stage III melanoma who were treated with DTIC/IL-2 combination therapy at a single institution from 2000 to 2010 were identified from the University of Louisville Hospital medical record. Patients received six months of subcutaneous IL-2 (12 × 106 units days 1 through 4) and intravenous DTIC (750mg/m2 day 1 of each cycle) every 28 days for 6 cycles. Individual medical records were accessed to collect the data.ResultsOf the 112 patients treated, all underwent surgical resection and then received adjuvant treatment. 58.7% of the patients were male, 42.2% female; 99% were Caucasian. 79 (72.5%) of the patients were alive at the time of analysis and 57 (47.7%) patients were currently event free. 69 (63.3%) patients completed all 6 months of adjuvant combination treatment with 13.8% of the patients requiring IL-2 and 21.1% of the patients requiring DTIC dose reduction. Five year OS was 75.57% with RFS of 53.05%.ConclusionsFor several decades, there has not been an ideal adjuvant treatment for patients with resected high risk melanoma. Our retrospective analysis suggests that combination therapy with DTIC/IL-2 is beneficial and relatively well tolerated as an alternative adjuvant treatment for patients with high-risk melanoma.
       
  • Advance Glycation End Products Stimulate Angiotensinogen Production in
           Renal Proximal Tubular Cells
    • Abstract: Publication date: Available online 24 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Joseph M. Garagliano, Akemi Katsurada, Kayoko Miyata, Andrei V. Derbenev, Andrea Zsombok, L. Gabriel Navar, Ryousuke SatouABSTRACTBACKGROUNDElevated advanced glycation end products (AGE) in diabetes mellitus (DM) are implicated in the progression of DM-associated tissue injury, including diabetic nephropathy. The intrarenal renin-angiotensin system, in particular augmentation of angiotensinogen (AGT) in proximal tubular cells (PTC), plays a crucial role in the development of diabetic nephropathy. This study investigated hypothesis that AGE stimulates AGT production in PTC.MATERIALS AND METHODSUrinary AGT and AGE levels in streptozotocin-induced DM mice were measured by enzyme-linked immunosorbent assays. AGT expression and secretion were evaluated in cultured rat PTC receiving 0-200 µg/ml AGE-BSA treatments for 24 hours. Furthermore, intracellular signaling pathways activated by AGE were elucidated.RESULTSDM mice exhibited greater urinary AGT and AGE levels compared to control mice (AGT: 21.6±5.5 ng/day vs. 190.1±57.8 ng/day, AGE: 139.1±21.6 ng/day vs. 332.8±102.7 ng/day). In cultured PTC, treatment with AGE-BSA enhanced AGT mRNA expression (3.43±0.11-fold compared to control), intracellular AGT protein levels (3.60±0.38-fold), and secreted AGT levels (2.11±0.18-fold). On the other hand, AGT levels were not altered in PTC receiving non-glycated BSA. Recombinant soluble AGE receptor, which competes with endogenous AGE receptor, diminished the AGE-induced AGT upregulation, suggesting that AGE-BSA stimulates AGT expression via activation of the AGE receptor. Enhanced phosphorylation of ERK1/2 and c-Jun, but not p38 MAP kinase, were observed in AGE-BSA-treated PTC. AGE-induced AGT augmentation was attenuated by an ERK inhibitor.CONCLUSIONSThe findings indicate that AGE enhances proximal tubular AGT expression via ERK1/2, which can exacerbate the development of diabetic related kidney injury.
       
  • Urinary and plasma cell free DNA comparison for lung cancer patients
           treated with epidermal growth factor receptor - thyroxine kinase
           inhibitors
    • Abstract: Publication date: Available online 23 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Haiying Yu, Mei Liu, Huibing Qiu, Kai Yang BackgroundMutations in the EGFR gene is known to affect treatment efficacy. Comparison of urinary and plasma cell free DNA allow possible non-invasive probing of disease mutationsMethodsA total of 130 patients with known epidermal growth factor receptor (EGFR) mutations derived from tissue biopsies were enrolled. Patients received thyroxine kinase inhibitor (TKI) therapy. Peripheral blood and urine specimens were collected at different time intervals and processed using digital droplet polymerase chain reaction (PCR). Concordance between specimens and the prognostic utility were evaluated with an observational study.ResultsPrior to treatment, we observed an overall agreement of 86.2% between tumor tissue and cell free DNA. Spearman rank correlation coefficient showed a strong correlation between plasma and urinary DNA results. In serial measurements following TKI therapy, secondary EGFR T790M mutation was observed. This occurred in 45% and 30% of non-small cell lung cancer (NSCLC) patients with urine and plasma samples, respectively. Progression free survival of patients with T790M mutation had worse outcome and hazard ratios for the study cohort using urinary and plasma DNA were 5.3 and 3.5 respectively.ConclusionsBoth urinary and plasma DNA presents new opportunities to detect mutations in non-small cell lung cancer (NSCLC) patients and provide real time updates to genetic profiles needed for treatment. In the current study, plasma DNA demonstrated better positive predictive value at baseline. For serial monitoring, we observed that changes in the T790M profiles were detected earlier in urine samples. The prognostic value of the assay can possibly aid in early clinical interventions.
       
  • Slipping Rib Syndrome: Solving the Mystery of the Shooting Pain
    • Abstract: Publication date: Available online 23 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Mohamad Y. Fares, Zakia Dimassi, Hasan Baydoun, Umayya MusharrafiehABSTRACTSlipping Rib Syndrome is an often unrecognized and underdiagnosed condition caused by the increased mobility of the anterior ends of the costal cartilages of the false ribs. Patients usually present with severe intermittent abdominal pain that is exacerbated by various physical movements. Diagnosis of Slipping Rib Syndrome is mainly clinical and can be confirmed by a physical examination technique termed the "Hooking Maneuver." Treatment includes conservative therapy, intercostal nerve block, and surgical operation. Hence, the management and care plan of each patient must be individualized as per the presenting symptoms and medical history. Early recognition and prompt intervention necessitate that physicians be more aware of the symptomatology and prognosis of this condition. This study presents a rare case of a patient with Slipping Rib Syndrome and offers medical insight to the clinical diagnosis and therapeutic modalities of this condition, in light of the current existing literature.
       
  • 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, Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome and complement-mediated hemolytic uremic syndrome. Thrombocytopenic purpura is diagnosed when ADAMTS13 is
       
  • 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
       
  • IgG4-Related Pleuritis With No Other Organ Involvement
    • Abstract: Publication date: Available online 9 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Toshiyuki Kita, Tomoyuki Araya, Yukari Ichikawa, Nanao Terada, Atsuhiro Kawashima, Satomi Kasashima, Kazuo Kasahara A 65-year-old man was admitted for productive cough and dyspnea. Bilateral pleural effusions were observed on chest X-ray. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, bacterial culture and polymerase chain reaction analysis for Mycobacterium tuberculosis were negative. Immunological examinations showed high levels of immunoglobulin G4 (IgG4) in both serum and pleural effusion fluid. Pathologic evaluation of a left pleural biopsy specimen using hematoxylin and eosin staining and immunohistochemical staining showed fibrosis-associated lymphoplasmacytic infiltration, 50 IgG4-positive plasma cells per high-power field, and an IgG4/IgG ratio of 40%. Thus, a diagnosis of IgG4-related pleuritis without other systemic manifestations was established. The bilateral pleural effusion improved following corticosteroid therapy. This is a rare case of IgG4-related pleuritis with no other organ involvement.
       
  • Prevalence and Incidence of Immune Thrombocytopenia in Patients With
           Prostate Cancer
    • Abstract: Publication date: Available online 5 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Namratha Vontela, Csaba Kovesdy, Zafar Latif, Robert Lane, Alva Weir
       
  • The Beat Goes On: The Story of 5 Ageless Cardiac Drugs
    • Abstract: Publication date: Available online 25 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Harold Smulyan This article traces the history of 5 cardiac drugs—Aspirin, Atropine, Digitalis, Nitroglycerine, and Quinidine—that have been in continuous use for centuries and some for longer. Four of the 5 started life as botanicals and 4 have as also served widely varied functions far removed from their current purposes. Collectively, they have played a role in the history of royalty, religious leaders, assassinations and military campaigns in addition to their place in medical therapy. Their present clinical status has evolved from long-term clinical observation without the need for controlled clinical trials, detailed statistical analyses or FDA approvals. This review of their background illustrates the varied means by which markedly different substances from widely separated sources can come together to participate in the management of circulatory disorders.
       
  • Acroosteolysis in Systemic Sclerosis
    • Abstract: Publication date: Available online 18 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Lujayn Akbar, Nuralhuda Akbar, Mona Al Muhaish, Shahrazad Akbar, Atef Kamar
       
  • Empyema secondary to transdiaphragmatic extension of pyogenic liver
           abscess
    • Abstract: Publication date: Available online 16 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Yu-Tse Sheih, Chih-Chiang Wang
       
  • Medical and Scientific Publishing in the 21st Century: A Search
           for Equipoise
    • Abstract: Publication date: Available online 16 October 2018Source: The American Journal of the Medical SciencesAuthor(s): Gailen D. Marshall
       
  • 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.
       
  • 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
       
  • 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
       
  • 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.
       
  • 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.
       
  • 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%.
       
  • 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.
       
  • 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
       
  • 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.
       
  • 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.
       
 
 
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