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  Subjects -> MEDICAL SCIENCES (Total: 7706 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (196 journals)
    - ANAESTHESIOLOGY (111 journals)
    - CARDIOVASCULAR DISEASES (318 journals)
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    - ENDOCRINOLOGY (145 journals)
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    - GASTROENTEROLOGY AND HEPATOLOGY (171 journals)
    - GERONTOLOGY AND GERIATRICS (128 journals)
    - HEMATOLOGY (145 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (147 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (94 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (1960 journals)
    - NURSES AND NURSING (314 journals)
    - OBSTETRICS AND GYNECOLOGY (191 journals)
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    - RHEUMATOLOGY (66 journals)
    - SPORTS MEDICINE (74 journals)
    - SURGERY (369 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (138 journals)

MEDICAL SCIENCES (1960 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
3D Printing in Medicine     Open Access   (Followers: 1)
AADE in Practice     Hybrid Journal   (Followers: 5)
ABCS Health Sciences     Open Access   (Followers: 3)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 41)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica (Hradec Králové)     Open Access  
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta Medica International     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access  
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 1)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 4)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 6)
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: 28)
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 Sciences     Hybrid Journal   (Followers: 6)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access  
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Regenerative Medicine     Open Access   (Followers: 2)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5)
Advances in Wound Care     Hybrid Journal   (Followers: 10)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 11)
African Health Sciences     Open Access   (Followers: 2)
African Journal of Biomedical Research     Open Access  
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 1)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 2)
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 8)
AJOB Primary Research     Partially Free   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal  
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 2)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
American Journal of Biomedical Engineering     Open Access   (Followers: 11)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 7)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 11)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 11)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 4)
American Journal of Medicine     Hybrid Journal   (Followers: 45)
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: 8)
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  
Anatomical Science International     Hybrid Journal   (Followers: 2)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy     Open Access  
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
Annales de Pathologie     Full-text available via subscription  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 1)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 10)
Annals of Family Medicine     Open Access   (Followers: 12)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 11)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 4)
Annual Review of Medicine     Full-text available via subscription   (Followers: 16)
Anthropological Review     Open Access   (Followers: 23)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 10)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arak Medical University Journal     Open Access  
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Medicine and Surgery     Open Access  
Archives of Trauma Research     Open Access   (Followers: 3)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access  
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 12)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 13)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access  
Asia Pacific Family Medicine     Open Access   (Followers: 1)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 10)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 3)
Asian Biomedicine     Open Access   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 5)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 3)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 2)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche     Open Access  
Audiology - Communication Research     Open Access   (Followers: 9)
Auris Nasus Larynx     Full-text available via subscription  
Australian Coeliac     Full-text available via subscription   (Followers: 1)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Avicenna     Open Access   (Followers: 3)
Avicenna Journal of Clinical Medicine     Open Access  
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 1)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 3)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 3)
Bangladesh Journal of Medical Physics     Open Access  
Bangladesh Journal of Medical Science     Open Access  
Bangladesh Journal of Medicine     Open Access   (Followers: 1)
Bangladesh Journal of Physiology and Pharmacology     Open Access  
Bangladesh Journal of Scientific Research     Open Access   (Followers: 1)

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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  [3159 journals]
  • Priority for treatment and intensive care of patients with non-severe
           community-acquired pneumonia
    • Abstract: Publication date: Available online 7 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Hai-yan Li, Qi Guo, Wei-dong Song, Yi-ping Zhou, Ming Li, Xiao-ke Chen, Hui Liu, Hong-lin Peng, Hai-qiong Yu, Xia Chen, Nian Liu, Zhong-dong Lü, Li-hua Liang, Qing-zhou Zhao, Mei Jiang BackgroundThe Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is unclear whether the patients with non-severe CAP meeting the minor criteria most strongly associated to mortality should have the priority for treatment and intensive care. It is warranted to explore this intriguing hypothesis.MethodsA retrospective cohort study of 1230 patients with CAP was performed. This was tested against a prospective 2-center cohort of 1749 adults with CAP.ResultsThe patients with CAP fulfilling the predictive findings most strongly associated to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality rates than those not fulfilling the predictive findings in subgroup analyses of the retrospective cohort. The more the number of predictive findings present, the higher the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly, the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly higher mortality rates compared with the patients with severe CAP not meeting the predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort. Two similar and intriguing paradigms about sequential organ failure assessment (SOFA) scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts.ConclusionsThe patients with non-severe CAP fulfilling the predictive findings most strongly associated to mortality demonstrated higher SOFA and PSI scores and mortality rates, and might have the priority for treatment and intensive care.
       
  • Broadening the differential diagnosis of IgG4-related pleuritis
    • Abstract: Publication date: Available online 6 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Oscar M.P. Jolobe
       
  • Honiton laces in oral cavity
    • Abstract: Publication date: Available online 1 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Shelly Arora, Ranjeet Ajit Bapat, Tanay Chaubal
       
  • Mitigation of stroke risk in nonvalvular atrial fibrillation patients with
           high grade carotid artery stenosis
    • Abstract: Publication date: Available online 1 August 2018Source: The American Journal of the Medical SciencesAuthor(s): Oscar M P Jolobe
       
  • Risk Factors for Low Pharmacy Refill Adherence among Older Hypertensive
           Men and Women by Race
    • Abstract: Publication date: Available online 29 July 2018Source: The American Journal of the Medical SciencesAuthor(s): LaKeisha G. Williams, Erin Peacock, Cara Joyce, Lydia A. Bazzano, Daniel Sarpong, Paul K. Whelton, Elizabeth W. Holt, Richard Re, Edward Frohlich, Jiang He, Paul Muntner, Marie Krousel-Wood BackgroundSex-race stratification may lead to identification of risk factors for low antihypertensive medication adherence that are not apparent when assessing risk factors in women and men without race stratification. We examined risk factors associated with low pharmacy refill adherence across sex-race subgroups (white women, black women, white men, black men) within the Cohort Study of Medication Adherence among Older Adults (n=2,122).MethodsPharmacy refill adherence was calculated as proportion of days covered (PDC) using all antihypertensive prescriptions filled in the year prior to a baseline risk factor survey. Sex- and sex-race-stratified multivariable Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios and 95% confidence intervals for associations between participant characteristics and low adherence.ResultsPrevalence of low adherence was 22.9% versus 40.7% in white versus black women (p
       
  • Association Between Aldehyde Dehydrogenase 2 Glu504Lys Polymorphism and
           Alcoholic Liver Disease
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Binxia Chang, Shuli Hao, Longyu Zhang, Miaomiao Gao, Ying Sun, Ang Huang, Guangju Teng, Baosen Li, David W. Crabb, Praveen Kusumanchi, Li Wang, Suthat Liangpunsakul, Zhengsheng Zou BackgroundOnly a subset of patients with excessive alcohol use develop alcoholic liver disease (ALD), though the exact mechanism is not completely understood. Once ingested, alcohol is metabolized by 2 key oxidative enzymes, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). There are 2 major ALDH isoforms, cytosolic and mitochondrial, encoded by the aldehyde ALDH1 and ALDH2 genes, respectively. The ALDH2 gene was hypothesized to alter genetic susceptibility to alcohol dependence and alcohol-induced liver diseases. The aim of this study is to determine the association between aldehyde dehydrogenase 2 (rs671) glu504lys polymorphism and ALD.MethodsALDH2 genotyping was performed in 535 healthy controls and 281 patients with ALD.ResultsThe prevalence of the common form of the single nucleotide polymorphism rs671, 504glu (glu/glu) was significantly higher in patients with ALD (95.4%) compared to that of controls (73.7%, P < 0.0001). Among controls, 23.7% had the heterozygous (glu/lys) genotype compared to 4.6% in those with ALD (odds ratio [OR] = 0.16, 95% CI: 0.09-0.28). The allele frequency for 504lys allele in patients with ALD was 2.3%, compared to 14.5% in healthy controls (OR = 0.13, 95% CI: 0.07-0.24).ConclusionsPatients with ALDH2 504lys variant were less associated with ALD compared to those with ALDH2 504glu using both genotypic and allelic analyses.
       
  • Fatal Hepatotoxicity Due to Viaminate
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Hui Zhang, Ji Zhang, Hongmei Dong Viaminate is a derivative of retinoic acid (tretinoin) used in the treatment of severe acne and other disorders of keratinization. Liver dysfunction due to viaminate therapy has not been well described and there have been no reported deaths due to viaminate-induced hepatotoxicity. Herein, we report the case of a woman who underwent treatment at the hospital for 38 days and died of hepatic failure after taking viaminate for more than 2 months. This case provides further insight into viaminate-induced hepatotoxicity.
       
  • Diagnosis and Management of Solitary Laryngeal Neurofibromas
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Lili Zhang, Juan Jiang, Chengping Hu, Huaping Yang, Pengbo Deng, Yuanyuan Li Solitary laryngeal neurofibromas are exceedingly rare with only 14 cases reported in the previous literature. Herein, we reported a case of solitary laryngeal neurofibroma and reviewed all the published cases of this disease on the clinical manifestations and management options. Patients with solitary laryngeal neurofibromas can present with a variety of respiratory symptoms. Immunohistochemical examination of tumor specimen is critical for pathologic diagnosis and complete surgical resection is the optimal therapy. Endoscopic microsurgeries followed by CO2 laser management of the surgical border may be effective on preventing recurrence. Depending on the location, size and invasiveness of the lesions, the management and prognosis vary among patients. Long-term follow-up is highlighted owing to the possibility of recurrence during a long period of time after surgery.
       
  • Pseudomelanosis Duodeni in the Setting of Chronic Hydralazine Use
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Marcus A. Toschi, George A. Salem, Mohammad Madhoun
       
  • TMPRSS2-ERG Fusion Promotes Recruitment of Regulatory T cells and Tumor
           Growth in Prostate Cancer
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Lei Shan, Tongyu Ji, Xiang Su, Qichao Shao, Tao Du, Shilong Zhang BackgroundThis study was designed to examine the effect of transmembrane protease serine 2 ETS-related gene (TMPRSS2-ERG) fusion on regulatory T cells and tumor growth in prostate cancer, which may provide a new potential therapeutic direction for PCa.MethodsThe effect of TMPRSS2-ERG fusion on the migration of Treg cells and tumor growth in a mouse model was investigated in vitro and in vivo. TMPRSS2-ERG fusion in biopsy tissues was performed by fluorescence in situ hybridization and the expression of ERG and Forkhead box P3 was detected by gel electrophoresis, real-time quantitative reverse transcription polymerase chain reaction and Western blot. Enzyme-linked immunosorbent assay and flow cytometry were used to analyze transforming growth factor β levels and the number of regulatory T cells, respectively. Finally, the infiltration of regulatory T cells was analyzed by Forkhead box P3 immunohistochemistry.ResultsFluorescence in situ hybridization analysis showed that the TMPRSS2-ERG fusion gene was positive in prostate cancer and that the messenger RNA and protein expression of ERG were significantly up-regulated in prostate cancer biopsy tissues. Furthermore, the number of regulatory T cells and the levels of Forkhead box P3 and transforming growth factor β were significantly increased in prostate cancer. TMPRSS2-ERG fusion increased the migration and activation of regulatory T cells in vitro and promoted subcutaneous tumor size and regulatory T cells infiltration in mouse models.ConclusionsTMPRSS2-ERG fusion can regulate the recruitment and infiltration of regulatory T cells to promote tumor growth in prostate cancer.
       
  • Immunological In Vivo and In Vitro Investigations of Aqueous Extract of
           Stem Bark of Pterocarpus erinaceus Poir (Fabaceae)
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Oumar Mahamat, Tume Christopher, Ateufack Gilbert, Ngo Teke Gerald, Kamanyi Albert BackgroundMacrophages are the first cells to recognize invading foreign bodies and are central to cell mediated and humoral immunity. Therefore, the activation of macrophages is a key event for effective innate and adaptive immunity. Pterocarpus erinaceus has been reported to control infectious diseases, but the mechanism remains to be elucidated. In this study, we demonstrated the immune-modulatory effect of aqueous extract of P. erinaceus using human macrophages and lymphocytes, as well as mice.MethodsHot water was used to extract P. erinaceus from the stem bark. Its effect on lymphocytes was measured by evaluating proliferative response and delayed hypersensitivity. Phagocytic activity of macrophages were measured based on neutral red uptake assay, nitric oxide production and myeloperoxidase and phosphatase acid activity. Hematopoietic and infectious activities were analyzed using the effect on infectious stress and chloramphenicol-induced leucopenic mice model.ResultsAqueous extract showed stronger stimulatory effects on the neutral red uptake, production of nitric oxide and phosphatase acid activity in lipopolysaccharide-activated macrophages. In addition, aqueous extract significantly stimulated the proliferation of phytohemagglutinin-activated lymphocytes, enhanced delayed hypersensitivity response to erythrocytes and attenuated infection-induced fever. Furthermore, aqueous extract also significantly increased the rate of recovery of white blood cell levels in chloramphenicol-induced leucopenia mice.ConclusionsThe results suggest that aqueous extract of P. erinaceus stem bark is able to modulate the immune system and has potential effects in clinical conditions when an immune-enhancing and anti-infectious effect is desired.
       
  • Sustained Cardiac Recovery Hinges on Timing and Natural History of
           Underlying Condition
    • Abstract: Publication date: July 2018Source: The American Journal of the Medical Sciences, Volume 356, Issue 1Author(s): Abhishek Jaiswal, Thierry H. Le Jemtel, Rohan Samson, Donna Mancini The review underlines that advanced heart failure (AHF) patients who experience sustained cardiac recovery in the current left ventricular assist device (LVAD) era have similar clinical characteristics to those who experienced myocardial recovery in the pre-LVAD era. They are young, do not have coronary artery disease and were treated for idiopathic dilated cardiomyopathy within weeks to months of experiencing symptoms. As recently shown with progressive remodeling of the transverse tubular system, AHF results in myocyte and extracellular matrix alterations that with time become irreversible. Young age, short duration of symptoms and LV systolic dysfunction as evidenced by smaller LV cavity dimension are primary determinants of sustained cardiac recovery in patients with AHF. Mechanical circulatory support can be life saving in patients with low-cardiac output and end-organ dysfunction. However, the underlying condition and not mechanical circulatory support appears to be the primary determinant of sustained myocardial recovery.
       
  • Ischemic Stroke After Plasmapheresis
    • Abstract: Publication date: Available online 29 March 2018Source: The American Journal of the Medical SciencesAuthor(s): Hisham Salahuddin, Ajaz Ahmad Sheikh, Sharmeen Hussaini, Cherian Verghese, Gretchen E. Tietjen Plasmapheresis involves the separation of all cellular elements of blood with the help of an extracorporeal semipermeable membrane. Even though plasmapheresis is generally considered safe, there have been anecdotal reports of thrombosis related to this exchange. We present 2 cases of healthy young males developing ischemic strokes within 24 hours of plasmapheresis. Patient A was a 24-year-old man with a family history of Factor V Leiden mutation presented with right-sided weakness 1 hour after donating plasma. A hypercoagulable work-up revealed elevations in Factor II. Patient B was a 42-year-old man who presented with a right facial droop, expressive aphasia and right arm weakness. He had donated plasma 18 hours before his presentation. A hypercoagulable work-up revealed elevated levels of von Willebrand factor antigen and high sensitivity C-reactive protein. A procoagulant state induced by plasmapheresis likely increases the risk for symptomatic thrombosis when an underlying thrombophilic state is present in the donor.
       
  • Acute Right Ventricular Heart Failure: An Uncommon Case of Thyrotoxicosis
    • Abstract: Publication date: Available online 27 March 2018Source: The American Journal of the Medical SciencesAuthor(s): Mariella Faccia, Angelo Porfidia, Massimo Montalto Right ventricular failure can be secondary to right ventricular ischemia, pulmonary or tricuspid valvular disease, myocardial shunts, cardiomyopathy, acute and chronic pulmonary hypertension, myocarditis and pericardial disease and it generally carries a poor prognosis. Thyrotoxicosis is a clinical state resulting from high thyroid hormone action in tissues generally due to high thyroid hormone levels. The association between severe hyperthyroidism and high-output heart failure is well-known. Less widespread is the concept that hyperthyroid patients, irrespective of coexisting diseases and through mechanisms not fully elucidated, are at higher risk for pulmonary hypertension and right heart failure, both reversible with the achievement of euthyroidism and associated with a good prognosis. We describe the case of a 44-year-old woman with right ventricular failure and moderate pulmonary hypertension in the setting of thyrotoxicosis, which resolved rapidly after antithyroid treatment. The potential mechanisms underlying this condition will also be discussed.
       
  • Emerging role for exosomes in the progress of stem cell research
    • Abstract: Publication date: Available online 19 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Yuan Kai-Ming, Zhang Pei-Hua, Qi Shan-Shan, Zhu Qiao-Zhen, Li Ping Exosomes are small secretory vesicles that are involved in intercellular communication. Exosomes are secreted by many types of cells and exert important functions in plasma-membrane exchange as well as the transport of bioactive substances, such as proteins, messenger ribonucleic acids (mRNAs), micro ribonucleic acids (miRNAs) and organelles. Exosomes may regulate physiological processes by altering gene regulatory networks or epigenetic recombination. Recent studies have shown that exosomes secreted by stem cells can effectively transport proteins, mRNAs and miRNAs and play important roles in the regulation of tissue regeneration. This report reviews current progress in exosome studies as well as their emerging roles in stem cell research and potential clinical use.
       
  • The Acute effects of cigarette smoking on the functional state of high
           density lipoprotein
    • Abstract: Publication date: Available online 19 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Si-Qi Shen, Hui Chang, Zi-Xi Wang, Hong-Ying Chen, Lian-Feng Chen, Feng Gao, Xiao-Wei Yan BackgroundCigarette smoking disturbs plasma lipid level and lipoprotein metabolism; however, the effects of smoking on the functional state of high density lipoprotein (HDL) are still not clear. This study aimed to determine the anti-oxidant and anti-chemotactic properties of HDL and HDL-mediated cholesterol efflux in healthy subjects after cigarette smoking.MethodsHealthy male subjects, including nonsmokers (n=16) and chronic smokers (n=8), were enrolled. After smoking 8 cigarettes within 2 hours, plasma HDL was isolated and tested. Copper-induced LDL oxidation was used to determine the anti-oxidant ability of HDL. The concentration of SAA was measured by ELISA. Chemotaxis was detected by transwell assay. HDL-mediated cholesterol efflux was measured using fluorescent cholesterol analog.ResultsLow density lipoprotein (LDL) baseline oxidation state was higher in chronic smokers than that in nonsmokers. Meanwhile, HDL-induced cholesterol efflux in macrophages in chronic smokers was significantly enhanced compared with that in nonsmokers. After acute smoking, both the anti-oxidant and anti-chemotactic ability of HDL declined in nonsmokers. However, in healthy chronic smokers, the effect of HDL on the susceptibility of LDL to oxidation was compensatorily enhanced. Nevertheless, their bodies were still in a higher oxidation state. Also, acute smoking did not affect HDL-mediated cholesterol efflux significantly in both nonsmokers and chronic smokers.ConclusionsOur data suggest that acute smoking attenuates the anti-oxidant and anti-chemotactic abilities of HDL in nonsmokers. Chronic smokers are in a higher oxidative state, although the anti-oxidant function of their HDL is compensatorily enhanced.
       
  • Hemophagocytic lymphohistiocytosis in the elderly
    • Abstract: Publication date: Available online 17 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Reyna Altook, Mohammed Ruzieh, Avneet Singh, Wael Alamoudi, Zeinab Moussa, Hussam Alim, Fadi Safi, Joan Duggan Hemophagocytic lymphohistiocytosis (HLH) is a rare disease of massive, dysregulated cytokine release and secondary multi-organ failure, and is associated with high mortality. Primary HLH occurs predominately in infants and young children with a genetic predisposition. Acquired HLH is less well characterized and usually occurs in younger adults in the setting of severe inflammation triggered by infection or malignancy. Little is known about the disease in elderly. We report 3 patients>50 years old who presented with multi-organ failure and shock without an identifiable source and were ultimately diagnosed with acquired HLH. We performed a literature review of HLH in adults>50 years of age and identified an additional 68 cases. Mean age was 62 years, with male predominance. Most cases were triggered by infection (49%) followed by malignancy (27%). Nineteen patients were treated with the HLH-94 protocol, 11 received corticosteroids and the remainder received non-HLH specific interventions. Overall mortality was 62%.
       
  • The clinical impact of glomerular immunoglobulin M deposition in patients
           with type 2 diabetic nephropathy
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Xi Tang, Hanyu Li, Li li, Junlin Zhang, Huan Xu, Lin Li, Fang Liu BackgroundGlomerular Immunoglobulin M (IgM) deposition is common in diabetic kidney disease. The clinical implication of IgM deposition in the renal tissues of type 2 diabetes (T2DM) patients with biopsy-proven diabetic nephropathy (DN) remains unclear.MethodsOne hundred thirty-two patients with T2DM and biopsy-proven pure DN were enrolled retrospectively. Clinicopathological features and renal outcomes were compared between patients with and without glomerular capillary IgM deposition. A Cox proportional hazards model was employed to identify the risk factors associated with renal survival.ResultsFifty-two patients had positive linear glomerular capillary IgM staining. Patients with glomerular capillary IgM deposition presented with heavier proteinuria, lower serum albumin, and lower immunoglobulin G (IgG) levels. During 35.5 (12, 107) months of follow-up, patients with glomerular tuft IgM deposition had shorter renal survival than those with negative IgM deposition (39 [23.74, 54.26] vs. 64 [45.82, 82.18] months, P = 0.01). Patients with glomerular C1q deposition showed worse renal survival than those lacking glomerular C1q deposition (36 [23.82, 48.18] vs. 60 [50.27, 69.74] months, P = 0.001). Worse renal outcome was observed in patients with glomerular C3 deposition than in those without glomerular C3 deposition (37 [22.43, 51.56] vs. 63 [51.75, 74.25] months, P = 0.001). Multivariate Cox proportional analysis demonstrated that combined glomerular capillary IgM and C1q deposition (HR 3.75, 95% CI [1.68, 8.35], P = 0.001) was an independent predictor of end-stage renal disease.ConclusionsPatients with diabetic nephropathy and combined glomerular capillary IgM and C1q deposition had unfavorable renal outcome, which indicates that IgM derived from B cells might be involved in diabetic kidney injury.
       
  • Does Timing Matter' Using Lactate to Predict Outcomes
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Michael Baram, Bharat Awsare
       
  • A case of Takayasu Arteritis with the ostium of left main coronary artery
           obstructed by prolapsed thickened ascending aortic intima
    • Abstract: Publication date: Available online 7 July 2018Source: The American Journal of the Medical SciencesAuthor(s): Jiayue Feng, Sen He, Hua Wang
       
  • Walter Reed at Camp Lazear: A Paradigm for Contemporary Clinical Research
    • Abstract: Publication date: Available online 5 July 2018Source: The American Journal of the Medical SciencesAuthor(s): David Ploth Throughout the time of the early settlement and development of North America there were frequent epidemics of Yellow Fever. Yellow fever was particularly threatening because it was associated with an extremely high mortality rate; up to 85% of those infected died of the disease. Yellow Fever in the Western world is likely an additional, horrific by-product of early slavery in North America. It is thought that ships transporting captured Africans likely conveyed both the major vector, the Aedes aegypti mosquito, and the RNA Yellow Fever virus from Africa to North America. Infected ships landing in port cities resulted in epidemics that proved impossible to control with conventional interventions. Walter Reed and the U.S. Army Commission solved the mystery of the mode of Yellow Fever transmission. Notably, Reed and his co-workers not only proved the mosquito the vector of transmission but did so by constructing focused research questions leading to cleverly devised experiments that resulted in definitive answers. The results of their research not only proved that the mosquito transmitted the disease, but disproved the other proposed modes of transmission. In nearly all respects Reed's experiments are an excellent paradigm for addressing clinical research questions today.
       
  • SAFMR/SSCI Junior Faculty Research Travel Awards
    • Abstract: Publication date: Available online 30 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Autoimmune thyroid disease in patients with systemic lupus erythematosus:
           a 7-year retrospective study in China
    • Abstract: Publication date: Available online 30 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Shanshan Wei, Zhenghui Yang, Shuangde Xie, Xuebiao Peng, Li Gong, Ke Zhao, Kang Zeng, Kuan Lai BackgroundThe study was a retrospective case-controlled study. We aimed to determine the clinical and laboratory features of systemic lupus erythematosus (SLE) and compared the features of autoimmune thyroid disease (AITD) with those of SLE.MethodsThe study included 38 patients with SLE with AITD (SLE-AITD) and 190 age- and gender-matched SLE patients. The distribution of sociodemographic and clinical factors was compared between the SLE-AITD and SLE groups using Chi-square tests for gender and t tests for others. Univariate and multivariate logistic regression models were used to identify factors associated with the prevalence of AITD among SLE patients.ResultsIn univariate analysis, malar rash, oral ulcers, serositis, anti-double-stranded DNA antibody positivity (anti-dsDNA+), anti-Sjögren's syndrome type A antibodies (SSA), anti-Sjögren's syndrome type B antibodies (SSB), low complement 3 (C3), and low complement 4 (C4) were significantly different between the SLE-AITD and SLE groups. There were no significant differences among other clinical or laboratory features. In multivariate analysis, serositis (adjusted odds ratio [AOR], 3.64; P = 0.00), anti-dsDNA+ (AOR, 0.30; P = 0.01) and low C3 (AOR, 0.30; P = 0.02) were all associated with SLE-AITD.ConclusionsIn our study, serositis was a risk factor for AITD, so we propose that AITD should be considered in lupus patients with serositis.
       
  • Executive Summary
    • Abstract: Publication date: Available online 26 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • HIGHLIGHTS FROM THE 2018 SOUTHERN REGIONAL MEETING
    • Abstract: Publication date: Available online 25 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Expression of cytosolic phospholipase A2 alpha in glioblastoma is
           associated with resistance to chemotherapy
    • Abstract: Publication date: Available online 25 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lei Yang, Haiyan Zhang BackgroundThe clinical management of glioblastoma is still challenging despite aggressive surgery and radio-chemotherapy approaches. Better understanding the molecules involved in glioblastoma chemoresistance is necessary to improve the treatment and predict prognosis.Materials and MethodsWe analyzed the expression and possible roles of cytosolic phospholipase A2 alpha (cPLA2α) in human glioblastoma cell lines and patient samples using immunohistochemistry and cellular assays. We analyzed the signaling pathways that cPLA2α regulates in glioblastoma cells using western blot.ResultsOur work demonstrated that cPLA2α is upregulated in glioblastoma compared with normal neuron cells. The expression of cPLA2α varies in multiple glioblastoma cell lines and is associated with chemoresistance rather than tumor development. cPLA2α depletion moderately inhibits glioblastoma growth and survival but remarkably sensitizes chemo-resistant glioblastoma cells to several chemotherapeutic agents. Mechanistically, cPLA2α knockdown significantly suppresses the PI3K/Akt/mTOR pathway in glioblastoma cells.ConclusionsWe are the first to identify the important role of cPLA2α in glioblastoma in response to chemotherapy. Our data also suggest that cPLA2α may serve as a biomarker to indicate prognosis of glioblastoma patients with high level of cPLA2α to chemotherapy.
       
  • Folliculotropic mycosis fungoides with CD30+ large-cell transformation
    • Abstract: Publication date: Available online 23 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lei Yao, Yan Yu, Yu Guo, Shan-shan Li
       
  • Complete Heart Block in Acute Aortic Dissection: An Unusual Presentation
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Kiran Kumar Gudivada, Ashish Kumar Umesh, Akarsh Reddy Budibetta Sudeendrababu
       
  • Thiamine deficiency: An important consideration in critically ill patients
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Pradeep Attaluri, Austin Castillo, Hawa Edriss, Kenneth Nugent Thiamine is an essential cofactor for 4 enzymes involved in the production of energy (ATP) and the synthesis of essential cellular molecules. The total body stores of thiamine are relatively small, and thiamine deficiency can develop in patients secondary to inadequate nutrition, alcohol use disorders, increased urinary excretion, and acute metabolic stress. Patients with sepsis are frequently thiamine deficient, and patients undergoing surgical procedures can develop thiamine deficiency. This deficiency can cause congestive heart failure, peripheral neuropathy, Wernicke's encephalopathy, Korsakoff's syndrome, and gastrointestinal beriberi. In addition, thiamine deficiency can contribute to the development of intensive care unit complications, such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction, and unexplained lactic acidosis. Consequently, clinicians need to consider thiamine deficiency in patients admitted to intensive care units and the development of thiamine deficiency during the management of critically ill patients. Intravenous thiamine can correct lactic acidosis, improve cardiac function, and treat delirium.
       
  • Efficacy and safety of policosanol plus fenofibrate combination therapy in
           elderly patients with mixed dyslipidemia: a randomized, controlled
           clinical study
    • Abstract: Publication date: Available online 21 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Hai–ya Wang, Qing–ping Jiao, Shu–yan Chen, Jing Sheng, Hua Jiang, Jie Lu, Song-bai Zheng, Ning-yuan FangABSTRACTBackgroundPolicosanol is a mixture of long-chain alcohols isolated from sugar cane. This controlled, randomized clinical trial was designed to compare the efficacy and safety of fenofibrate, policosanol and a combination of these 2 in lowering low-density-lipoprotein cholesterol (LDL-C) in elderly patients with mixed dyslipidemia.MethodsA total of 102 patients aged ≥60 years were randomly assigned into 3 groups: patients receiving a 24-week therapy of fenofibrate (200 mg/day), policosanol (20 mg/day), or fenofibrate + policosanol combination. Lipids were evaluated at baseline, after 16- and 24-weeks of therapy. Brachial-ankle pulse wave velocity (ba-PWV) was performed, and SF-36 questionnaires were used to evaluate the patients’ quality of life. The primary endpoint was the percentage reduction in LDL-C. The secondary endpoints included percentage change in non-high density lipoprotein cholesterol(non-HDL-C), total cholesterol (TC), triglyceride (TG), high-density-lipoprotein cholesterol (HDL-C), ba-PWV and SF-36 scores. Safety was assessed by adverse events and laboratory parameters.ResultsLDL-C, non-HDL-C and TC were decreased respectively after treatment with policosanol for 24 weeks (P
       
  • Sex-based Differences in Heart Failure with Preserved Ejection Fraction
           Reflected by B-type Natriuretic Peptide Level,
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Eisaku Harada, Yuji Mizuno, Fumihito Kugimiya, Makoto Shono, Hiroyuki Maeda, Naotsugu Yano, Hirofumi Yasue BackgroundPrevalence of heart failure with preserved ejection fraction (HFpEF) increases with advancing age, particularly among women. Plasma levels of B-type natriuretic peptide (BNP), a surrogate marker of HF, have consistently been shown to be higher in women in the general populations. Whether BNP levels differ as per the sex of HFpEF patients remains largely unknown.Materials and MethodsThe study subjects were 733 HFpEF patients (204 men and 529 women, aged 80.9 ± 9.6 years) who underwent echocardiography and routine clinical examination, including plasma BNP level evaluation. These parameters were compared between women and men.Results: Plasma levels of BNP were significantly lower in women than in men [104 (61, 192) vs. 133 (78, 255) pg/mL, P < 0.001], just as hemoglobin, atrial fibrillation, diabetes mellitus, beta-blockers, left ventricular diastolic dimension, left ventricular mass index, left ventricular eccentric hypertrophy, and left atrial dimension were. Age, systolic blood pressure, pulse pressure, heart rate, left ventricular relative wall thickness, left ventricular ejection fraction, and left ventricular concentric hypertrophy were higher in women than in men. Multiple regression analyses revealed that left ventricular mass index, body massn index, early diastolic mitral flow velocity/tissue annular motion velocity/left ventricular diastolic dimension, estimated glomerular filtration rate, beta-blockers, left atrial dimensions, female sex, and atrial fibrillation were significant predictors for BNP levels (t = 5.41, P < 0.001, t = -4.06, P < 0.001, t = 3.76, P < 0.001, t = -3.68, P < 0.001, t = 3.32, P = 0.001, t = 3.11, P = 0.002, t = -3.07, P = 0.002, and t = 2.65, P = 0.008, respectively).ConclusionsPlasma BNP levels were lower in women and were related to left ventricular concentric remodeling/hypertrophy among HFpEF patients, contrary to those in the general population.
       
  • Is Dietary Protein Intake Predictive of One-Year Mortality in Dialysis
           Patients',,✰✰✰
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): David P. Murray, Lufei Young, Jennifer Waller, Stephanie Wright, Rhonda Colombo, Stephanie Baer, Vanessa Spearman, Rosalia Garcia-Torres, Kori Williams, Mufaddal Kheda, N. Stanley Nahman BackgroundHigh mortality in dialysis patients may be associated with protein-energy wasting (PEW) syndrome characterized by progressively depleted protein and energy stores. While early diagnosis and treatment of PEW can reduce mortality, clinically practical measures for its detection are lacking. Poor dietary protein intake (DPI) is associated with risk of malnutrition and PEW. However, the impact of DPI on mortality is unclear. The purpose of this study is to examine the ability of DPI to predict 1-year mortality in dialysis patients.MethodsThis prospective, secondary study using data from the Comprehensive Dialysis Study (CDS) and United States Renal Data System examined risk factors associated with 1-year mortality in dialysis patients.ResultsSeventeen (7.5%) of the 227 subjects died within 1 year following baseline data collection. One year survivors were significantly younger (60±13.6 vs. 71±12.8; P = 0.0043), had a lower Charlson Comorbidity Index (CCI) score (1.6±2.3 vs. 4.0±3.6; P = 0.0157), higher serum albumin level (3.5±0.5 vs. 3.3±0.4; P = 0.0173), and had higher DPI (63±33.7 vs. 49.5±21.5 g/day; P = 0.0386) than those who died. In multivariable Cox proportional hazards model analyses, only the CCI adjusted hazard ratio for death (1.24) was significantly associated with increased mortality. The CDS data showed no association between DPI and 1-year mortality in dialysis patients.ConclusionsFuture studies using more precise measures should further examine the impact of DPI on mortality given the known association of DPI with PEW syndrome and the definitive link between PEW syndrome and survival in dialysis patients.
       
  • Complications of Cirrhosis in Primary Care: Recognition and Management of
           Hepatic Encephalopathy
    • Abstract: Publication date: Available online 19 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Steven L. Flamm Approximately 3.7% of patients in primary care settings have chronic liver disease, and 18% with chronic liver disease, in the specialty care setting, have cirrhosis. For cirrhotic patients without complications, prognosis is generally favorable; increased morbidity and mortality are observed when complications (ie, hepatic encephalopathy [HE]) occur. HE occurs in up to 70% of patients with cirrhosis. Neurologic signs in HE span a wide spectrum, from those not easily apparent (covert) to more clinically obvious signs (overt). Providers should consider overt HE in patients with cirrhosis and signs of impaired cognition, confusion, consciousness and/or personality changes, and/or impaired memory. Overt HE treatment includes identifying and treating precipitating factors and reducing bacterial-derived toxin loads. For acute overt HE, lactulose is first-line treatment. To prevent HE recurrence, lactulose plus rifaximin is recommended. Patients with cirrhosis and HE often present in primary care; recognizing and properly managing HE are important in this setting.
       
  • Effect of trimetazidine on preventing contrast-induced acute kidney injury
           in patients with diabetes
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Weidai Zhang, Kefei Wu, Hanfei Lin, Jiawei Zhang, Songming Chen
       
  • "This is a Christian institution and we will tolerate no Jews here": The
           Brooklyn Medical Interns Hazings
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Edward C. Halperin Anti-Semitic quotas to restrict access to medical school, graduate medical education, and hospital privileges were common in the US from the 1920’s to the 1960’s. In Brooklyn, New York, medical education prejudice resulted in violence. In 1916 a Jewish intern at Kings County Hospital (KCH), Matthew Olstein, was bound and gagged by Christian interns, put on a train at Grand Central Station, and warned that if he returned he would be thrown in the East River. Olstein died in combat in World War I as an Army physician. In 1927 three Jewish interns at KCH were assaulted, bound, dumped in tubs of water, and covered in black fluid. Six gentile physicians were charged with assault. Criminal proceedings and public investigations followed. These attacks are the only known episodes of violence associated with American medical education anti-Semitism.
       
  • Sepsis: An update in current practices in diagnosis and management
    • Abstract: Publication date: Available online 18 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Snigdha Jain Despite several advancements in care over the last few decades, sepsis continues to carry a high morbidity and mortality burden in the United States. With its varied presentations, cases of sepsis are likely to be encountered by general practitioners in both inpatient and outpatient settings. In the recent years, there has been much debate about the appropriate criteria to diagnose patients with sepsis with a concurrent change in management guidelines. This article reviews definitions, diagnosis and treatment guidelines in current practice in the management of patients with sepsis.Case presentationA 60-year-old man presented to the emergency department with a 2-day history of chills and dysuria. His medical history was significant for hypertension for which he was taking amlodipine 5 mg daily. Vital signs in the emergency department were significant for a temperature of 38.7°C (101.5°F), heart rate of 120 beats/minute, blood pressure of 90/60 mm Hg, respiratory rate of 20 breaths/ minute, and oxygen saturation of 95% on room air. Physical examination revealed dry mucous membranes, tachycardia without gallops, rubs, or murmurs, clear lungs and warm extremities. Abdominal exam was significant for tenderness on palpation of his suprapubic region. Laboratory testing showed a creatinine level of 1.6 mg/dL (reference range, 0.5 to 1.1 mg/dL) - up from a baseline creatinine of 0.9 mg/dL 4 weeks prior, blood urea nitrogen of 56 mg/dL (reference range, 7 to 20 mg/dL), white-cell count of 18,000/mm3 (reference range, 4500 to 11,000 cells/mm3), hemoglobin of 9.0 g/dL (reference range, 12.0 to 15.5 g/dL) and lactate of 2 mmoL/L (reference range, 0.5-2 mmoL/L). Urinalysis showed 3+ leukocyte esterase,>100 white cells per high-power field, and many bacteria.Does this patient have sepsis' How would you treat him'
       
  • FROM SQUIRRELS TO BIOLOGICAL WEAPONS: THE EARLY HISTORY OF TULAREMIA
    • Abstract: Publication date: Available online 15 June 2018Source: The American Journal of the Medical SciencesAuthor(s): J.V. Hirschmann After George McCoy accidentally discovered a new infection in 1911 while investigating bubonic plague in squirrels, he transmitted the disease to experimental animals and isolated the causative organism. He called it Bacterium tularense, after Tulare County, California. In 1919, Edward Francis determined that an infection called “deer-fly fever” was the same disease, naming it “tularemia.” He demonstrated that it occurred in wild rabbits and inadvertently showed that it was highly infectious, for he and all his laboratory assistants contracted the illness. This characteristic led to studies of its potential as a biological weapon, including involuntary human experimentation by Japan among civilian, political and military prisoners, and its probable use in warfare during World War II. Later, in the United States, voluntary human experimentation occurred in the 1950s-60s with penitentiary inmates and non-combatant soldiers. Soviet Union scientists allegedly developed a vaccine-resistant strain, which they tested as a biological weapon in 1982-3.
       
  • Extensive Calcinosis Cutis in Overlap Syndrome
    • Abstract: Publication date: Available online 13 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Yamen Homsi
       
  • Hematuria and Renal Outcomes in Patients with Diabetic Chronic Kidney
           Disease
    • Abstract: Publication date: Available online 12 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Hugo You-Hsien Lin, Sheng-Wen Niu, I-Ching Kuo, Lee-Moay Lim, Daw-Yang Hwang, Jia-Jung Lee, Shang-Jyh Hwang, Hung-Chun Chen, Chi-Chih Hung BackgroundHematuria may indicate nondiabetic renal disease in diabetic chronic kidney disease (CKD). However, some studies have reported that hematuria is noted in diabetic nephropathy and is associated with albuminuria. Hematuria is a risk factor for end-stage renal disease in glomerulonephritis, but its prognostic value in diabetic CKD is unknown. We investigated the factors associated with hematuria and the prognostic value of hematuria in patients with diabetic CKD.Material and MethodsWe included 1958 patients with type 2 diabetes and CKD stages 1–5, and 111 patients underwent renal biopsy. Patients in the biopsied cohort were younger and had more severe proteinuria, compared with those in the total cohort; hematuria was associated with nondiabetic renal disease.ResultsIn the total cohort, hematuria was observed in 15.0% of the patients and was associated with young age, a lower estimated glomerular filtration rate, proteinuria, high blood pressure, and short diabetes duration. Hematuria was significantly associated with an increased risk (hazard ratio 1.39, 95% CI: 1.10–1.76, P < 0.001) of end-stage renal disease, particularly in patients with CKD stages 1–3 or a urine protein-to-creatinine ratio of
       
  • Sudden Cardiac Arrest in a Young Patient with Severe Pectus
           Excavatum,
    • Abstract: Publication date: Available online 9 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Rayan Jo Rachwan, Andrea K. Purpura, Basil M. Kahwash We report a case of sudden cardiac arrest in the setting of ventricular fibrillation in a previously healthy 19-year-old male. Chest imaging demonstrated severe pectus excavatum with Pectus Severity Index of 22.7. Extensive workup was unrevealing for other cardiopulmonary etiologies, including conduction and structural abnormalities. The patient was scheduled for a Ravitch procedure and was discharged on a wearable defibrillator vest for temporary protection against ventricular arrhythmias. Later, the patient underwent subcutaneous implantable cardioverter defibrillator placement. Sudden cardiac arrest as an initial presentation of pectus excavatum is a rare entity scarcely discussed in medical literature. In this patient-centered focused review, we explore this unique case and offer our management approach amid the lack of concrete guidelines.
       
  • Timing of Left Ventricular Remodeling in Non-ischemic Dilated
           Cardiomyopathy,,✯✯✯
    • Abstract: Publication date: Available online 8 June 2018Source: The American Journal of the Medical SciencesAuthor(s): William S. Bradham, Susan P. Bell, Shi Huang, Frank E. Harrell, Douglas W. Adkisson, Mark A. Lawson, Douglas B. Sawyer, Henry Ooi, Marvin W. KronenbergABSTRACTBackground: Mineralocorticoid receptor antagonist (MRA) treatment produces beneficial left ventricular (LV) remodeling in nonischemic dilated cardiomyopathy (NIDCM). This study addressed the timing of maximal beneficial LV remodeling in NIDCM when adding MRA.Methods: We studied 12 patients with NIDCM on stable beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor-blocking therapy who underwent cardiac magnetic resonance imaging before and after 6-31 months of continuous MRA therapy.Results: At baseline, the LV ejection fraction (LVEF) was 24 (19, 27)% (median, interquartile range). The LV end-systolic volume index (LVESVI) was 63 (57, 76) ml, and the LV stroke volume index (LVSVI) was 19 (14, 21) ml, all depressed. After adding MRA to the HF regimen, the LVEF increased to 47 (42, 52)%, with a decrease in LVESVI to 36 (33, 45) ml, and increase in LVSVI to 36 (28, 39) ml (for each, P 
       
  • The S-Curve Discontinuity Theory Applied to Medicine to Explain
           Healthcare's Past and Predict Its Future
    • Abstract: Publication date: Available online 6 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lisa B.E. Shields, Tyler A. Gertz, Kenneth C. Wilson, Ginger L. Figg, Steven T. Hester, Joshua T. Honaker Developed in 1845 by Verhulst, the logistic growth curve is an “S” shaped sigmoid curve referring to the self-limiting population growth in ecology. The initial growth stage is exponential, followed by slowing of growth as saturation begins, and ending of growth at maturity. In geology, an uncertain period exists at the upper horizontal arm of the S-curve when a species utilizes its available resources, and either extinction or evolution by natural selection results.The S-curve has been used in biology, physics, mathematics, chemistry, economics, sociology, oncology, and statistics. The S-curve theory has been applied to medicine to describe the advancements in the 20th century based on the diagnosis and treatment of disease (the “illness” model) and envision the future focused on disease prevention (the “wellness” model). We expand upon previous S-curve applications in medicine and discuss the obstacles facing the present-day healthcare industry and the numerous advancements that are imminent.
       
  • Hyponatremia complicating esophageal carcinoma: a challenging differential
           diagnosis
    • Abstract: Publication date: Available online 6 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Lina Mackelaite, Eleanor Lederer Hyponatremia is a common complication of cancer and of cancer therapy. Awareness of the many causes of hyponatremia in this setting is critical for ordering the appropriate diagnostic tests, instituting the appropriate treatment, and assessing prognosis of the disorder. This case report highlights the challenges in identifying the cause of hyponatremia in some oncology settings and how misdiagnosis can delay appropriate therapy.
       
  • Shiga Toxin as a Potential Trigger of CFHR1 deletion- associated
           Thrombotic Microangiopathy
    • Abstract: Publication date: Available online 5 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Swarna Sri Nalluru, Meera Sridharan, Ronald S. Go, Samar Said, Ariela L. Marshall Thrombotic microangiopathy (TMA) may result from a variety of clinical conditions, including thrombotic thrombocytopenic purpura (TTP), Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS), and complement-mediated hemolytic uremic syndrome (C-HUS). TTP is diagnosed when ADAMTS13 is
       
  • Editorial
    • Abstract: Publication date: Available online 5 June 2018Source: The American Journal of the Medical SciencesAuthor(s):
       
  • Women's Health in Inflammatory Bowel Disease
    • Abstract: Publication date: Available online 2 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Sai S. Veerisetty, Stephanie O. Eschete, Ann-Porter Uhlhorn, Kara M. De Felice About half of all inflammatory bowel disease (IBD) patients are women. It is important that physicians are aware of gender-specific needs women with IBD may have. This review covers general and specific women's health issues related to their IBD. It is intended to be practical and give a brief overview of topics including body image, menstruation, contraception, cervical cancer screening, preconception counseling, anxiety, depression, pregnancy, breastfeeding, menopause, skin exams, vaccines, laboratory monitoring and bone health.
       
  • Spectrum of Gastrointestinal Manifestations in Joint Hypermobility
           Syndromes
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Gehan Botrus, Omar Baker, Erica Borrego, Kyari Sumayin Ngamdu, Mohamed Teleb, Jose L. Gonzales Martinez, Gerardo Maldonado, Ahmed M. Hussein, Richard McCallum Joint hypermobility is a common, primarily benign finding in the general population. However, in a subset of individuals joint hypermobility causes a range of clinical problems mainly affecting the musculoskeletal system and, to a lesser extent, extra-articular disorders. Joint hypermobility often appears as a familial trait and is shared by several inherited connective tissue disorders, including the hypermobility subtype of Ehlers-Danlos syndrome (hEDS) and benign joint hypermobility syndrome (BJHS/JHS). Although joint hypermobility has primarily been thought of as a rheumatological disorder, increasing evidence shows significant associations between both hEDS and BJHS with specific extra-articular disorders. To date, the strongest associations of these 2 conditions are with anxiety disorders, orthostatic tachycardia, various functional gastrointestinal (GI) disorders and pelvic and bladder dysfunction. This review article focuses on GI disorders associated with both hEDS and BJHS. The aim of this review is to evaluate existing research and literature regarding associations between JHS (hEDS/BJHS) and GI disorders. Our goal is to raise awareness of BJHS/JHS and hEDS as an explanation for chronic unexplained symptoms and functional GI disorders as well as to review the current standard tests available for proper evaluation of GI symptoms in these patients.
       
  • Not All Gastric “Masses” Need a Biopsy—A Cautionary Tale
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Divyansh Bajaj, Roni Manyevitch, Gordon Gray Still
       
  • Pegylated Interferon-α Plus Ribavirin Therapy Improves Left Ventricular
           Diastolic Dysfunction in Patients With Chronic Hepatitis C Attaining
           Sustained Virological Response
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Abdul-Quddus Mohammed, Ranshaka Auckle, Hai-Ling Li, Si-Ling Xu, Lu Liu, Dong-Dong Zhao, Wen-Liang Che BackgroundPegylated interferon (pegIFN) in combination with ribavirin (RBV) has successfully improved the rate of sustained virological response (SVR) in chronic hepatitis C virus (HCV) infected individuals, which reduces the progression of the chronic liver disease. However, the influence of combination therapy (pegIFN/RBV) on cardiac function has yielded ambiguous results. The present study aimed to evaluate the effects of combination therapy with pegIFN/RBV on cardiac function of HCV-infected individuals with SVR.Materials and MethodsCardiac function was assessed and correlated in 142 treatment-naïve patients with HCV infections by determining cardiac biomarkers and echocardiography before treatment and for 24 weeks post-treatment.ResultsAn SVR was achieved by 50.7% of all patients. Serum N-terminal pro-B-type natriuretic peptide levels were significantly higher in all patients before treatment and decreased significantly 24 weeks post-treatment in the SVR group (62.84 [36.98-102.73] versus 22.87 [15.64-56.92] pg/mL, P < 0.01). Peak early diastolic annular velocity (E′) was significantly lower (7.69 ± 2.48 versus 9.74 ± 2.68 cm/s, P < 0.001) and E/E′ was higher (10.04 ± 2.51 versus 8.18 ± 2.31, P < 0.001) in all patients with SVR. However, there were no statistically significant differences in biomarkers and echocardiographic parameters for patients without SVR. In addition, multivariate analysis identified age (odds ratio [OR] = 1.076; 95% CI: 1.031-1.125; P < 0.001), NT-proBNP (OR = 1.122; 95% CI: 1.002-1.248; P = 0.015), and SVR (OR = 0.532; 95% CI: 0.214-0.895; P = 0.023) as statistically significant independent variables associated with left ventricular diastolic dysfunction.ConclusionsThe present study showed no adverse effects of combination therapy on cardiac function of HCV-infected individuals with SVR. Subsequent viral eradication resulted in improvement of left ventricular diastolic dysfunction.
       
  • The Relationship Between Vascular Endothelial Growth Factor Cis- and
           Trans-Acting Genetic Variants and Metabolic Syndrome
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Mohsen Azimi-Nezhad, Seyed Reza Mirhafez, Maria G. Stathopoulou, Helena Murray, Ndeye Coumba Ndiaye, Abdollah Bahrami, Abdoreza Varasteh, Amir Avan, Amelie Bonnefond, Marc Rancier, Hassan Mehrad-Majd, Bernard Herbeth, John Lamont, Peter Fitzgerald, Gordon A. Ferns, Sophie Visvikis-Siest, Majid Ghayour-Mobarhan BackgroundWe have investigated the association between 4 cis- and trans-genetic variants (rs6921438, rs4416670, rs6993770 and rs10738760) of the vascular endothelial growth factor (VEGF) gene and metabolic syndrome (MetS) and its individual components in an Iranian population.Material & MethodThree hundred and thirty-six subjects were enrolled and MetS was defined according to the International-Diabetes-Federation (IDF) criteria. Genotyping was carried out in all the individuals for 4 VEGF genetic variants using an assay based on a combination of multiplex polymerase chain reaction and biochip array hybridization.ResultsAs may be expected, patients with MetS had significantly higher levels of serum high-sensitivity C-reactive protein, waist circumference, hip circumference, body mass index, fat percentage, systolic blood pressure, diastolic blood pressure and triglyceride, whereas the high-density lipoprotein cholesterol levels were significantly lower, compared to the control group (P < 0.05). We also found that 1 of the VEGF- level associated genetic variants, rs6993770, was associated with the presence of MetS; the less common T allele at this locus was associated with an increased risk for MetS. This association remained significant after adjustment for confounding factors (P = 0.007). Individuals with MetS carrying the AT + TT genotypes had markedly higher levels of fasting blood glucose, triglyceride and systolic blood pressure (P < 0.05).ConclusionsWe have found an association between the rs6993770 polymorphism and MetS. This gene variant was also associated with serum VEGF concentrations. There was also an association between this variant and the individual components of the MetS, including triglyceride, fasting blood glucose and systolic blood pressure.
       
  • Association of Substance Use With Hospitalization and Virologic
           Suppression in a Southern Academic HIV Clinic
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Celensia Tolson, Lauren E. Richey, Yujing Zhao, Jeffrey E. Korte, Kathleen Brady, Louise Haynes, Eric G. Meissner BackgroundPersons with HIV infection who do not achieve virologic suppression contribute significantly to the ongoing HIV epidemic and have an increased risk of clinical sequelae related to immunosuppression. The extent to which substance use and mental health diagnoses affect HIV outcomes and the care continuum has not been previously assessed at the Medical University of South Carolina (MUSC), a large academic HIV clinic.MethodsTo address this knowledge gap and identify targets for intervention, we performed a retrospective chart review to examine associations of substance use and mental health diagnoses with hospitalization and virologic suppression.ResultsPatients with substance use or mental health diagnoses had increased rates of hospitalization and lower rates of sustained longitudinal HIV suppression. Prevalence of distinct substance-related disorders differed by race and sex. Although cocaine, alcohol and cannabis use were common, documented opiate use disorder was surprisingly infrequent given the ongoing opioid epidemic in South Carolina.ConclusionsThese data suggest effective assessment and treatment of substance use disorders will help improve the HIV care continuum in South Carolina.
       
  • Clinical Characteristics and Outcomes in Young Patients With ST-Segment
           Elevation Myocardial Infarction After Primary Percutaneous Coronary
           Intervention
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Ming Gao, Waiou Zhao, Zhiguo Zhang, Ling Qin, Weihua Zhang, Yang Zheng BackgroundThere are few published studies of ST-segment elevation myocardial infarction (STEMI) in younger individuals. The differences between these “younger” and “older” individuals may not be fully appreciated by clinicians. The aim of this study was to determine the reasons for the earlier presentation and help to identify strategies for prevention of recurrent myocardial infarction (MI) in younger patients.MethodsThe study population was a cohort of 2,419 consecutive STEMI patients who were treated with primary percutaneous coronary intervention. The median follow-up time of this retrospective study was 2.2 years.ResultsThe all-cause mortality rates in patients ≤45 years of age at 30 days, 1 and 2 years were 1.7%, 2.0% and 2.2%, respectively. These rates were lower compared with their older matched counterparts whose all-cause mortality rates were 3.3%, 4.2% and 5.5%, respectively (P = 0.010). The incidence of recurrent MI was 4.0% for all age groups combined, 5.4% for younger patients and 3.8% for older patients. The number of stents showed association with recurrent MI in older patients with a first infarction, whereas only composition factor 1 with significantly higher non–high-density lipoprotein and low-density lipoprotein values was significantly associated with recurrent MI in the younger patients.ConclusionsSTEMI patients ≤45 years of age more often had lower rates of all-cause mortality, but the risk of recurrent MI was similar to that of older patients. Regardless of triglyceride level, neither non–high-density lipoprotein nor low-density lipoprotein were independent predictors for recurrent MI during the long-term follow-up in younger patients.
       
  • Increased Cystatin C Level in ST-Elevation Myocardial Infarction
           Predisposes the Prognosis of Angioplasty
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Guidong Shen, Hongmin Zhu, Hong Ding, Chaoyang Sun, Kun Zhou, Yan Fan, Tao Li, Min Men, Yuewu Chen, Qun Lu, Aiqun Ma BackgroundThe study aimed to evaluate the prognostic value of cystatin C in ST-elevation acute myocardial infarction (STEMI) patients who underwent elective percutaneous coronary intervention (PCI).MethodsA retrospective study was conducted on 664 STEMI patients from 7 centers who were treated with elective PCI. These patients were divided into 3 groups according their admission cystatin C levels as < 0.84, 0.84-1.03 and ≥1.04 mg/L. The all-cause mortalities and the composite endpoints, including mortality, reinfarction, rehospitalization for heart failure and angina or repeat target vessel revascularization were observed for up to 5 years.ResultsAs cystatin C levels from low to high, all-cause mortalities were progressively increased 0.9%, 3.7% and 9.5% (P < 0.001), as well as the composite endpoints, 11.1%, 21.7% and 40.7%, respectively (P < 0.001). When patients had the level of cystatin C ≥0.84 mg/L, their risks of composite endpoints increased 2- to 3-fold of those with
       
  • Antibiotic Timing and Outcomes in Sepsis
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Richard Y. Kim, Alex M. Ng, Annuradha K. Persaud, Stephen P. Furmanek, Yash N. Kothari, John D. Price, Timothy L. Wiemken, Mohamed A. Saad, Juan J. Guardiola, Rodrigo S. Cavallazzi BackgroundWe evaluated the effect of time spent in the emergency department (ED) and process of care on mortality and length of hospital stay in patients with sepsis or septic shock.MethodsAn observational cohort study was conducted on 117 patients who came through the University of Louisville Hospital ED and subsequently were directly admitted to the intensive care unit (ICU). Variables of interest were time in the ED from triage to physical transport to the ICU, from triage to antibiotic(s) ordered, and from triage to antibiotic(s) administered. Expected mortality was calculated according to the University Health System Consortium Database. Primary and secondary outcomes were in-hospital death and hospital length of stay in days, respectively.ResultsWe found no significant association between time in the ED and mortality between survivors and nonsurvivors (5.5 versus 5.7 hours, P = 0.804). After adjusting for expected mortality, a 22% increase in mortality risk was found for each hour delay from triage to antibiotic(s) ordered; a 15% increase in mortality risk was observed for each hour from triage to antibiotic(s) given. Both time from triage to antibiotic(s) ordered (hazard ratio [HR] = 0.8, P = 0.044) and time from triage to antibiotic(s) delivery (HR = 0.79, P = 0.0092) were independently associated with an increased hospital stay (HR = 0.79, P = 0.0092).ConclusionThough no significant association between mortality and ED time was demonstrated, we observed a significant increase in mortality in septic patients with both delays in antibiotic(s) order and administration. Delay in care also resulted in increased hospital stays both overall and in the ICU.
       
  • The Timing of Antibiotic Administration After Triage in the Emergency
           Department May Not Be Straight Forward!
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Steven Clum, Mark Rumbak
       
  • Quantitating Heart Damage: Part of the Story
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): L. Julian Haywood
       
  • Macrophage Migration Inhibitory Factor—A Potential Target for
           Diabetes Prevention'
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Sri Prakash L. Mokshagundam
       
  • An offer we can't refuse: cfDNA as a novel biomarker of myocardial
           infarction
    • Abstract: Publication date: Available online 1 June 2018Source: The American Journal of the Medical SciencesAuthor(s): Daria V. Ilatovskaya, Kristine Y. DeLeon-Pennell
       
  • A Huge Pancreas Tumor With Periampullary Invasion
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Yu-jen Chen, Ching-Liang Lu
       
  • About a Suggestive Association Between Fanconi Anemia and Laron Syndrome
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): I. Castilla-Cortazar, G.A. Aguirre, J.R. De Ita
       
  • In Reference to Fanconi Anemia and Laron Syndrome
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Benilde García-de Teresa, Sara Frias
       
  • Biventricular Thrombi in a Patient With Heart Failure With Severely
           Reduced Ejection Fraction and Heterozygous Prothrombin 20210G/A and
           Homozygous Methylenetetrahydrofolate Reductase 677C/T Mutations
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Htoo Kyaw, Fatima Shaik, Won J. Park, Deepika Misra Thrombus in the heart is known to be one of the many sequelae of anterior wall myocardial infarction, atrial fibrillation and coagulation disorders. However, biventricular thrombi are relatively rarely found, even in conditions with a high possibility of thrombus formation. We report the case of a 75-year-old-woman with newly diagnosed systolic heart failure secondary to a nonischemic cardiomyopathy, who was found to have large biventricular thrombi. Further coagulopathy work-up revealed that she was heterozygous for the prothrombin 20210G/A and homozygous for the methylenetetrahydrofolate reductase (MTHFR) 677C/T mutations. We, herein, review and discuss previous case reports and published literature regarding ventricular thrombosis and its treatment. To the best of our knowledge, this is the first case of biventricular thrombosis with prothrombin 20210G/A and MTHFR 677C/T mutations.
       
  • The First Reported Case of Cytomegalovirus Gastritis in a Patient With
           End-Stage Renal Disease
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Chi-Hao Liu, An-Hang Yang, Shuo-Ming Ou, Der-Cherng Tarng Cytomegalovirus (CMV) infection is a common infectious complication in immunocompromised patients. The colon is the most common site of CMV infection in the gastrointestinal tract. Rarely, however, invasion of the upper gastrointestinal tract, such as the esophagus or stomach, has been reported. Herein, we describe the first reported case of CMV gastritis in a patient with end-stage renal disease and uremic symptoms (including nausea, vomiting, and poor appetite) who had begun hemodialysis therapy. This patient was not a transplant recipient and was not receiving immunosuppressant treatment. As CMV gastritis is easily over looked in patients with end-stage renal disease, physicians should maintain a high index of suspicion and establish the diagnosis as early as possible using an upper GI endoscopic biopsy and adequate staining.
       
  • Erythropoietin Enhances Bone Repair Effects via the Hypoxia-Inducible
           Factor Signal Pathway in Glucocorticoid-Induced Osteonecrosis of the
           Femoral Head
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Donghai Li, Qinsheng Hu, Gang Tan, Xiaowei Xie, Zhouyuan Yang, Pengde Kang BackgroundThis study aimed to determine whether erythropoietin could repair glucocorticoid-induced osteonecrosis of the femoral head after the systemic or local administration of recombinant human erythropoietin.Materials and MethodsGelatin microspheres were used to load recombinant human erythropoietin for local delivery. Forty-eight Wistar rats were included in the glucocorticoid-induced osteonecrosis of the femoral head model and randomly divided into the placebo, systemic erythropoietin and local erythropoietin groups. Eight weeks later, all rats were killed and their tissues were subjected to radiographic, histological, histometric, quantitative polymerase chain reaction and western blot analyses.ResultsOur results show that the use of recombinant human erythropoietin increased bone volume, trabecular number, trabecular thickness and trabecular separation compared with the placebo. Erythropoietin administration significantly improved the expression of runt-related transcription factor 2, alkaline phosphates, hypoxia-inducible factor-1α and vascular endothelial growth factor in the femoral head. We also found that the local injection of erythropoietin could better mediate hypoxia-inducible factor-1α–controlled osteogenic and angiogenic factor expression and better repair the glucocorticoid-induced osteonecrosis of the femoral head.ConclusionsThe use of recombinant human erythropoietin exerted effects on improving the bone structures in glucocorticoid-induced osteonecrosis of the femoral head and up-regulated the expression of runt-related transcription factor 2, alkaline phosphates, hypoxia-inducible factor-1α and vascular endothelial growth factor. It provided a novel idea that erythropoietin administration could repair glucocorticoid-induced osteonecrosis of the femoral head by improving bone formation and angiogenesis and may be associated with the hypoxia-inducible factor-1α pathway. The sequential delivery of erythropoietin from gelatin microspheres seems worth recommending.
       
  • Tetrahydroxy Stilbene Glucoside Alleviates High Glucose-Induced MPC5
           Podocytes Injury Through Suppression of NLRP3 Inflammasome
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Jinfeng Li, Bing Wang, Guangjie Zhou, Xiujuan Yan, Yuan Zhang BackgroundTetrahydroxy stilbene glucoside (TSG) is an active ingredient of Heshouwu and is an antioxidant. The underlying mechanisms of the renoprotective effect of TSG in diabetic nephropathy have not been previously reported. In this study, we investigated the mechanisms of TSG in preventing podocytes injury in high glucose (HG) condition.MethodsCultured mouse podocytes (MPC5) were incubated in HG (30 mmol/L) plus various concentration of TSG (0.1, 1 and 10 μM) for 48 hours. Reactive oxygen species (ROS) production, malondialdehyde (MDA) levels, terminal deoxynucleotidyl-transferase (TdT)-mediated dUTP-biotin nick end-labeling (TUNEL) fluorescence intensity, caspase-3 activity and the mRNA expression of nephrin in cultured podocytes were determined. The protein expression of Nod-like receptor protein 3 (NLRP3) inflammsome, interleukin-1β (IL-1β) and nephrin was detected by Western blot.ResultsWhen the podocytes were incubated with various concentrations of TSG under HG conditions for 48 hours, TSG decreased ROS production, MDA levels, TUNEL fluorescence intensity and caspase-3 activity, but increased cell viability and the expression of nephrin in HG-induced podocytes in a dose-dependent manner. Subsequently, the podocytes treated with TSG at 10 μΜ decreased the expression of NLRP3 inflammasome and IL-1β compared with that of control. Furthermore, the podocytes transfected with NLRP3- small interfering RNA (siRNA) exhibited a significant decrease in the expression of caspase-1 and IL-1β, but exhibited a significant increase in the expression of nephrin. Eventually, TSG significantly increased the expression of nephrin in IL-1β-treated podocytes.ConclusionsTSG attenuates high glucose-induced cell apoptosis in vitro partly through the suppression of NLRP3 inflammasome signaling.
       
  • The 50/10 Oxygen-Induced Retinopathy Model Serves as a Hyperoxia and
           Hypoxia Model of Bronchopulmonary Dysplasia
    • Abstract: Publication date: June 2018Source: The American Journal of the Medical Sciences, Volume 355, Issue 6Author(s): Huijuan Li, Ruyuan Zhu, Lijuan Qian, Wen Jin, Jiali Xie, Shumin Kang, Lijun Lu, Mingyu Tao, Li Jiang BackgroundAnimal models of bronchopulmonary dysplasia (BPD) are mainly created by hyperoxia exposure. However, these models do not fully recapitulate BPD pathophysiology as observed in clinical practice. To find a better BPD model, we established a rat 50/10 oxygen-induced retinopathy (OIR) model and analyzed the pathologic features of the lungs.MethodsThe rat OIR model was established by exposing newborn rats (P0) to 50% and 10% oxygen (hyperoxia and hypoxia) on alternating days for 14 days. Lungs were harvested immediately on postnatal day 14 (P14) and on P18 after 4 days of normoxia exposure for hematoxylin and eosin staining, antialpha smooth muscle actin (α-SMA) immunohistochemistry and Picrosirius red staining of collagen. Retinas were obtained to confirm successful model establishment by isolectin B4 staining of retinal vasculature.ResultsOIR rats presented with fewer and enlarged alveoli, and the septal walls were thicker than those in age-matched controls. α-SMA immunohistochemistry indicated increased abundance of myofibroblasts in OIR rats. At P18, α-SMA-positive myofibroblasts were present at extremely low levels from the alveolar walls of control rats, while OIR rats showed myofibroblast persistence. The amount of collagen in OIR rats was also higher than that in control rats at both P14 and P18 as evidenced by Picrosirius red staining.ConclusionsAlveolar changes observed by hematoxylin and eosin staining, prolonged and stronger α-SMA expression and augmented collagen accumulation resemble the histopathology of BPD, suggesting that the rat 50/10 OIR model is suitable for use in BPD research.
       
  • Tricuspid Regurgitation Pressure Gradient As a Useful Predictor Of Adverse
           Cardiovascular Events And All-cause Mortality In Patients With Atrial
           Fibrillation
    • Abstract: Publication date: Available online 22 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Po-Chao Hsu, Wen-Hsien Lee, Chun-Yuan Chu, Wei-Chung Tsai, Hung-Hao Lee, Chee-Siong Lee, Hsueh-Wei Yen, Tsung-Hsien Lin, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu, Ho-Ming Su BackgroundTricuspid regurgitation pressure gradient (TRPG) is reportedly a predictor of cardiovascular mortality in patients without atrial fibrillation (AF); its relationship with cardiac outcomes in patients with AF has never been evaluated. This study aimed to examine the ability of TRPG for predicting CV events and all-cause mortality in patients with AF.Materials and MethodsComprehensive echocardiography was performed in 155 patients with persistent AF. Combined cardiovascular events were defined as cardiovascular mortality, stroke, and hospitalization for heart failure.ResultsDuring an average follow-up period of 27 months, 57 cardiovascular events and 31 all-cause deaths occurred. According to multivariate analysis, predictors of cardiovascular events included diuretic use, decreased left ventricular ejection fraction (LVEF), increased ratio of transmitral E velocity (E) to early diastolic mitral annular velocity (E′), and TRPG. Predictors of all-cause mortality included old age, decreased LVEF, increased E/E′, and TRPG. Notably, the addition of TRPG to a model containing clinical significant parameters, LVEF, and E/E′ significantly improved the values in predicting adverse cardiovascular events and all-cause mortality.ConclusionsThe TRPG is not only a useful predictor of adverse cardiovascular events and all-cause mortality in patients with AF, it may also provide additional prognostic values for cardiovascular outcome and all-cause mortality over conventional parameters in such patients.
       
  • The Summer Enrichment Program: A Multidimensional Experiential Enriching
           Experience for Junior Medical Students
    • Abstract: Publication date: Available online 16 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Abdulhadi A. AlAmodi, Ahmed Abu-Zaid, Abdulaziz M. Eshaq, Khaled Al-Kattan
       
  • Variation in high-intensity statin use after hospitalization for acute
           vascular emergencies
    • Abstract: Publication date: Available online 16 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Anusha Shanbhag, Aneesha Ananthula, Raga Deepak Reddy Palagiri, Richa Parikh, Raghunandan Purushothaman, Srikanth Vallurupalli
       
  • 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 was 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–eosin 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
       
  • Multimodality diagnosis of Mirizzi syndrome.
    • Abstract: Publication date: Available online 4 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Gunjan Garg, Marisa Deliso, Shuo Li
       
  • 1 &rft.title=American+Journal+of+the+Medical+Sciences&rft.issn=0002-9629&rft.date=&rft.volume=">Experiential Learning in Medical Education 1
    • Abstract: Publication date: Available online 3 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Urvashi Vaid
       
  • Hepatitis B virus infection is independently associated with advanced
           colorectal adenoma
    • Abstract: Publication date: Available online 2 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Su Hwan Kim, Ji Won Kim, Kook Lae Lee, Seohui Lee, Seong-Joon Koh, Ji Bong Jeong, Byeong Gwan Kim IntroductionStudies on the association of chronic hepatitis B virus (HBV) infection with colonic neoplasm are rare. We aimed to investigate the association between chronic HBV infection and the development of colonic adenoma.Materials and MethodsOne hundred thirty-three patients with chronic HBV infection, who underwent colonoscopic examination, were enrolled. A healthy HBV-uninfected group was matched with the HBV group. Those with a previous history of colorectal cancer, inflammatory bowel diseases, or colorectal surgery were excluded from both HBV and HBV-uninfected groups. Clinical information and data on age, sex, body mass index, smoking, alcohol consumption, and comorbidities were obtained. Advanced adenoma was defined as tubular adenoma ≥ 10 mm, or adenoma with a villous component or high-grade dysplasia.ResultsThe HBV group had a higher rate of colorectal adenoma and advanced adenoma than the HBV-uninfected group. Patients in the HBV group had larger colorectal polyps than those in the HBV-uninfected group. In the chi square test, HBV DNA positivity was significantly associated with colorectal adenoma (P < 0.001) and advanced adenoma (P = 0.007). HBV infection (odds ratio [OR] 23.961, 95% CI 9.400–61.076), diabetes mellitus (OR 2.633, 95% CI 1.071–6.473), and age (OR 1.057, 95% CI 1.020–1.095) were significantly associated with advanced adenoma in the multivariable logistic regression analysis. Multivariable logistic regression analysis within the HBV group revealed that HBV DNA (OR 1.236, 95% CI 1.029–1.485) was associated with advanced adenoma.ConclusionsHBV DNA in patients with HBV infection and HBV infection are independently associated with advanced colorectal adenoma development.
       
  • Congenital Absence of Left Coronary Artery Accompanied by Premature
           Ventricular Complexes
    • Abstract: Publication date: Available online 1 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Hong-Feng Jin, Xiao-Wei Liu, Chang-Qing Du
       
  • BRCA2 Loss-of-Function and High Sensitivity to Cisplatin-Based
           Chemotherapy in a Patient With a Pleomorphic Soft Tissue Sarcoma: Effect
           of Genomic Medicine
    • Abstract: Publication date: Available online 1 May 2018Source: The American Journal of the Medical SciencesAuthor(s): Camille Tlemsani, Eric Pasmant, Pascaline Boudou-Rouquette, Audrey Bellesoeur, Julien Even, Frédérique Larousserie, Cécile Reyes, David Gentien, Jérôme Alexandre, Michel Vidaud, Philippe Anract, Karen Leroy, François Goldwasser We report the case of a patient with a BRCA2 germline mutation who developed a localized pleomorphic soft tissue sarcoma of the leg with poor prognostic features. BRCA2 germline mutations were not previously reported to be associated with pleomorphic sarcoma. BRCA2 loss-of-heterozygosity was found in the tumor, resulting in a complete BRCA2 loss-of-function. BRCA2 deficiency is associated with sensitivity to cisplatin-based chemotherapy in breast and ovarian cancer patients. We used a cisplatin-based chemotherapy. A rapid major partial response was obtained, which allowed a curative and conservative surgical resection of the sarcoma followed by adjuvant irradiation. This case illustrates that sarcoma patients may present unexpected but targetable genetic abnormalities and that BRCA2 loss-of-function may be targetable in sarcoma as it is associated with enhanced sensitivity to cisplatin. Our observation emphasizes the input of genomic medicine in clinical practice, its importance for treatment decisions, and the overlap between constitutional and somatic genetics.
       
  • Clopidogrel Partially Counteracts Adenosine-5′-Diphosphate Effects on
           Blood Pressure and Renal Hemodynamics and Excretion in Rats
    • Abstract: Publication date: Available online 27 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Malwina Monika Roszkowska-Chojecka, Agnieszka Walkowska, Janusz Sadowski, Leszek Dobrowolski BackgroundAdenosine-5′-diphosphate (ADP) can influence intrarenal vascular tone and tubular transport, partly through activation of purine P2Y12 receptors (P2Y12-R), but their actual in vivo role in regulation of renal circulation and excretion remains unclear.MethodsThe effects of intravenous ADP infusions of 2-8 mg/kg/hour were examined in anesthetized Wistar rats that were untreated or chronically pretreated with clopidogrel, 20 mg/kg/24 hours, a selective P2Y12-R antagonist. Renal blood flow (transonic probe) and perfusion of the superficial cortex and medulla (laser-Doppler fluxes) were measured, together with urine osmolality (Uosm), diuresis (V), total solute (UosmV), sodium (UNaV) and potassium (UKV) excretion.ResultsADP induced a gradual, dose-dependent 15% decrease of mean arterial pressure, a sustained increase of renal blood flow and a 25% decrease in renal vascular resistance. Clopidogrel pretreatment attenuated the mean arterial pressure decrease, and did not significantly alter renal blood flow or renal vascular resistance. Renal medullary perfusion was not affected by ADP whereas Uosm decreased from 1,080 ± 125 to 685 ± 75 mosmol/kg H20. There were also substantial significant decreases in UosmV, UNaV and UKV; all these changes were attenuated or abolished by clopidogrel pretreatment. Two-weeks’ clopidogrel treatment decreased V while UosmUosmV and UNaV increased, most distinctly after 7 days. Acute clopidogrel infusion modestly decreased mean arterial pressure and significantly increased outer- and decreased inner-medullary perfusion.ConclusionsOur functional studies show that ADP can cause systemic and renal vasodilation and a decrease in mean arterial pressure, an action at least partly mediated by P2Y12 receptors. We confirmed that these receptors exert tonic action to reduce tubular water reabsorption and urine concentration.
       
  • Silent Information Regulator 1 Negatively Regulates Atherosclerotic
           Angiogenesis Via Mammalian Target of Rapamycin Complex 1 signaling pathway
           
    • Abstract: Publication date: Available online 25 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Runtai Chen, Zhenchun Huang, Junyi Wang, Yingxiao Chen, Yucai Fu, Wei Wang BackgroundThis study aimed to investigate the interactions between silent information regulator 1 (SIRT1) and mammalian target of rapamycin (mTOR) in intraplaque angiogenesis and their potential mechanisms through in vivo and in vitro studies.MethodsAn atherosclerosis model was established in 12 rabbits on a high-cholesterol diet. The rabbits were equally divided into 3 groups: a control group (high-lipid diet), RAP group (high-lipid diet supplemented with rapamycin), and RAP + NAM group (high-lipid diet supplemented with rapamycin and nicotinamide). At the end of 4 weeks, the area of plaques in the aorta was determined and the protein expression of CD31 and vascular endothelial growth factor (VEGF) was detected through hematoxylin and eosin staining and immunohistochemical staining, respectively. For in vitro study, a hypoxia model was established in human umbilical vein endothelial cells (HUVECs) by using the chemical method (CoCl2). The MTT assay, scratch assay, and tube formation assay were performed to evaluate the proliferation and angiogenesis abilities of HUVECs. Reverse transcription polymerase chain reaction was used to examine the mRNA levels of SIRT1, hypoxia-inducible factor-1α (HIF-1α), mTOR, and p70 ribosomal S6 kinase (p70S6K). Western blotting was used to examine the protein levels of SIRT1, HIF-1α, mTOR, p-mTOR, p-raptor, and p-p70S6K.ResultsThe results of the in vivo study indicated a significant inhibitory effect of rapamycin on plaque size and intraplaque angiogenesis (0.05 ± 0.02 mm2 vs 5.44 ± 0.50 mm2, P < 0.05). This effect was attenuated by nicotinamide (0.76 ± 0.15 mm2 vs 0.05 ± 0.02 mm2, P < 0.05). Compared with the RAP group, CD31- and VEGF-positive vessels were abundant in the RAP + NAM group. The RAP group showed lower expression of p-mTOR, p-p70S6K, and HIF-1α than did the control group (P < 0.05), whereas the RAP + NAM group showed slightly higher expression of these factors than did the RAP group (P < 0.05). Furthermore, in vitro studies revealed that the inhibitory effect of rapamycin on the angiogenic ability of HUVECs and its significant inhibitory effects on the protein level of HIF-1α and the phosphorylation of proteins involved in the mTORC1 pathway, including mTOR, raptor, and p70S6K (P < 0.05), were enhanced by cotreatment with SRT1720 and rapamycin (P < 0.05). In contrast to mTOR and SIRT1, the mRNA levels of p70S6K and HIF-1α were reduced by rapamycin (P < 0.05) and further reduced by cotreatment with SRT1720 and rapamycin.ConclusionsThe study results indicate that SIRT1 might negatively regulate atherosclerotic angiogenesis via mTORC1 and HIF-1α signaling pathway and cointervention of SIRT1 and mTOR may serve as a crucial therapeutic strategy in cardiovascular medicine.
       
  • The Beat Goes On: The Story of Five Ageless Cardiac Drugs
    • Abstract: Publication date: Available online 25 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Harold SmulyanThis paper 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.
       
  • Safely Extubating the Acutely Ill Stroke Patient: By Which Criteria, and
           to What Purpose'
    • Abstract: Publication date: Available online 24 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Eric E. Smith, Philippe Couillard
       
  • Modifiable Predictors of In-Hospital Mortality in Patients Undergoing
           Transcatheter Aortic Valve Replacement
    • Abstract: Publication date: Available online 12 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Oluwaseun A. Akinseye, Muhammad Shahreyar, Chioma C. Nwagbara, Mannu Nayyar, Salem A. Salem, Mohamed Morsy, Rami N. Khouzam, Uzoma N. Ibebuogu BackgroundTranscatheter aortic valve replacement (TAVR) has become an acceptable therapy for patients with severe aortic valve stenosis at high or prohibitive surgical risk. Attempts are ongoing to validate risk prediction models for in-hospital mortality after TAVR. Our aim was to define modifiable risk factors predictive of in-hospital mortality after TAVR.MethodsWe identified patients who underwent TAVR from the 2012 database of the National Inpatient Sample. Patients who died during the index hospitalization were compared to those that were successfully discharged. The predictors of in-hospital mortality were analyzed using multivariate logistic regression.ResultsA total of 1360 patients (mean age 81 ± 8.8 years, whites 80.1%, blacks 3.5%) had TAVR and 68 (5%) died during hospitalization [X2 (1, n = 1360) = 1101.6, P < 0.001]. The average length of hospital stay was 8.33 ± 6.7 days. The positive predictors of in-hospital mortality in the unadjusted model were comorbidities such as congestive heart failure, coagulopathy, fluid and electrolyte disorder, weight loss, and history of drug abuse. Hypertension was a negative predictor of in-hospital mortality. Following multivariate analysis and adjustment for possible confounders, fluid and electrolyte disorder was the only significant positive predictor of in-hospital mortality (odds ratio [OR] 1.89, CI: 1.11–3.22, P = 0.019). The odds of in-hospital mortality were reduced in patients with hypertension (OR 0.45, CI: 0.26–0.78, P = 0.004).ConclusionsFluid and electrolyte disturbance could be a modifiable predictor of in-hospital mortality following TAVR. Efforts should be geared towards reducing its occurrence in this patient population.
       
  • Acute myocardial infarction patients show strong variations in circulating
           cell free DNA and correlated to clinical manifestations
    • Abstract: Publication date: Available online 11 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Jin Xie, Jiawei Yang, Pei Hu BackgroundThe objective of the study was to examine the potential use of circulating cell free DNA (cfDNA) in acute myocardial infarction (AMI) patients and correlate it with clinical features. Serial monitoring was conducted to assess any associations to disease.MethodsQuantification of cfDNA was performed on 130 cardiovascular disease (CVD) patients as well as 30 healthy volunteers. Serial samplings were conducted using PicoGreen dsDNA assay. Of the 130 patients with CVD, 100 had an AMI and measurements were taken during treatment. Short and medium intervals serial sampling of patients′ blood were undertaken.ResultsThe results were highly correlative of CVD disease status. The mean concentration of cfDNA in patients with AMI was 5 folds higher during the onset of disease compared with healthy volunteers. The cfDNA content was also higher than other patients with CVD. Interestingly, short term monitoring of patients with AMI showed distinct trends that highlighted the severity of the disease and linked to complication events. Medium term monitoring showed 2 distinctive groups with 1 that had their cfDNA returned to basal levels and the other with persistently elevated cfDNA levels.ConclusionsMeasuring cfDNA in patients with CVD offers an alternative approach to monitor the disease and has potential clinical applications to identify high-risk individuals.
       
  • Coding and Non-coding Variants in CFH Act Synergistically for Complement
           Activation in Immunoglobulin A Nephropathy
    • Abstract: Publication date: Available online 11 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Wei-yi Guo, Qing-zhen Liu, Li Zhu, Zeng-yan Li, Si-jun Meng, Su-fang Shi, Li-jun Liu, Ji-cheng Lv, Ping Hou, Hong Zhang BackgroundIn immunoglobulin A nephropathy (IgAN), complement activation occurs in both the systemic circulation and in situ (glomerular). A recent IgAN- genome-wide association study (GWAS) identified 1q32 as an IgAN susceptible locus that contained the complement regulatory protein coding gene complement factor H (CFH). Here, we explored the combined genetic effects of coding and non-coding variants in CFH, rs6677604 and rs800292 on complement activation in IgAN.MethodsIn total, 1194 IgAN patients and 900 healthy controls who were the same as the Beijing Discovery Cohort in our recent IgAN-GWAS were recruited. The genotyping information of rs800292 and rs6677604 were extracted from GWAS data, while the information regarding plasma C3 levels and mesangial C3 deposits were collected from medical records.ResultsWe found both rs800292-GG and rs6677604-GG were risk genotypes for complement activation in IgAN patients, as represented by lower plasma C3 levels in IgAN patients with rs800292-GG and a higher intensity of glomerular C3 deposits in those with rs6677604-GG, respectively. Additionally, IgAN patients with 2 risk genotypes (rs800292-GG and rs6677604-GG) showed a higher degree of complement activation compared to those with no risk genotypes (rs800292-AA/AG and rs6677604-AA/AG), as represented by both lower plasma C3 levels and a higher intensity of glomerular C3 deposits. Moreover, when compared to rs800292 or rs6677604 alone, the combined genetic effects of rs800292 and rs6677604 showed a stronger association with IgAN susceptibility.ConclusionsOur findings suggested that both coding and non-coding variants in CFH acted synergistically to regulate the degree of complement activation and thereby contributed to IgAN susceptibility.
       
  • Lancisi’s Sign: The Giant Venous Wave
    • Abstract: Publication date: Available online 7 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Nicolas Johner, Thibault Ronchard, Olivier Boillat, Georgios Giannakopoulos, Florian Rey
       
  • Dilemma of Common Bile Duct Dilatation in Opium-addicts: A
           Population-based Study on Prevalence and Clinical Outcome
    • Abstract: Publication date: Available online 7 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Amir Reza Radmard, Faezeh Khorasanizadeh, Hossein Poustchi, Soheil Kooraki, Babak Mirminachi, Maryam Sharafkhah, Elham Jafari, Amir Pejman Hashemi Taheri, Rasoul Stoudehmanesh, Mehdi Mohamadnejad, Reza Malekzadeh, Shahin Merat BackgroundThis study aimed to evaluate the association of various opium-related factors with common bile duct (CBD) diameter in opium-addicts in the general population and investigate the clinical importance and long-term outcomes.Materials and MethodsIn this prospective study, 2400 participants were randomly selected from the Golestan Cohort study. Opium consumption data were recorded. CBD diameter was measured by ultrasound. Transient elastography was performed at enrollment and 3 years later. Participants were followed up for at least 5 years.ResultsA total of 1599 individuals, aged above 50 years, were enrolled and 167 subjects were opium-addicts. CBD diameter was significantly higher in opium-addicts than controls (mean ± standard deviation:5.54 ± 1.95 vs. 4.74 ± 1.34 mm, P < 0.001). This difference was noted with all opium types, but mostly by heroin users (P < 0.001). Ingestion of opium caused greater CBD dilatation than inhalation (coefficient: 1.16; 95% confidence interval (CI) = 0.05–2.27, P = 0.04 vs. coefficient: 0.98; 95% CI = 0.75–1.20, P < 0.001). Transient elastography results did not show any association between fibroscan score change and CBD diameter. No major related malignancy was seen during follow-up.ConclusionThis study strengthened the evidence of an association of opium use with increased CBD diameter in a population-based setting without significantly increased risk of pancreaticobiliary malignancies or liver fibrosis. We cautiously suggest that opium-induced CBD dilatation may not require further diagnostic work-up.
       
  • High prevalence of renal sat wasting without cerebral disease as cause of
           hyponatremia in general medical wards
    • Abstract: Publication date: Available online 7 April 2018Source: The American Journal of the Medical SciencesAuthor(s): John K. Maesaka, Louis J. Imbriano, Nobuyuki Miyawaki BackgroundThe approach to hyponatremia is in a state of flux, especially differentiating syndrome of inappropriate antidiuretic hormone secretion (SIADH) from cerebral-renal salt wasting (RSW) because of diametrically opposite therapeutic goals. Considering RSW can occur without cerebral disease, we determined the prevalence of RSW in the general hospital wards.MethodsTo differentiate SIADH from RSW, we utilized an algorithm based on fractional excretion (FE) of urate and non-response to saline infusions in SIADH as compared to excretion of dilute urines and prompt increase in serum sodium in RSW.ResultsOf 62 hyponatremic patients, a) 17 patients (27%) had SIADH, 11 were non-responsive to isotonic saline, and 5 normalized a previously high FEurate after correction of hyponatremia, b) 19 patients (31%) had a reset osmostat (RO) based on normal FEurates and spontaneously excreted dilute urines; c) 24 patients (38%) had RSW, 21 had no clinical evidence of cerebral disease, 19 had saline-induced dilute urines; 2 had undetectable plasma ADH levels when urine was dilute, 10 required 5% dextrose in water to prevent rapid increase in serum sodium, 11 had persistently increased FEurate after correction of hyponatremia and 10 had baseline UNa < 20 mEq/L; d) 1 patient had Addison′s disease with a low FEurate and e) 1 patient (1.6% )had hyponatremia due to hydrochlorothiazide.ConclusionsOf the 24 patients with RSW, 21 had no cerebral disease, supporting our proposal to change cerebral to RSW. Application of established pathophysiologic standards and a new algorithm based on determination of FEurate were superior to the volume approach or determination of urinary sodium [UNa] when identifying the cause of hyponatremia.
       
  • Down-Regulation of miR-218-5p Promotes Apoptosis of Human Umbilical Vein
           Endothelial Cells Through Regulating High-Mobility Group Box-1 in
           Henoch-Schonlein Purpura
    • Abstract: Publication date: Available online 5 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Shao-Fei Yu, Wan-Yu Feng, Shao-Qing Chai, Xiao-Bo Meng, Zhong-Xia Dou, Hua Zhu BackgroundApoptosis of human umbilical vein endothelial cells (HUVECs) plays an important role in the progression of Henoch-Schonlein purpura (HSP). In the present study, we explored the function of miR-218-5p in HUVEC apoptosis and HSP development.Materials and MethodsHSP rat model was established and peripheral blood mononuclear cells (PBMC) were isolated. The expression of miR-218-5p and high-mobility group box-1 (HMGB1) protein in HUVECs was determined by quantitative real-time polymerase chain reaction and western blot, respectively. Cell apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. The association between miR-218-5p and HMGB1 was determined by luciferase assay. The endogenous expression of related genes was modulated with recombinant plasmids and cell transfection.ResultsMiR-218-5p was down-regulated and HMGB1 was up-regulated in vessels of the lower limb of HSP rats and in HUVECs co-cultured in HSP PBMC supernatant. MiR-218-5p negatively regulated HMGB1 by targeting its 3′-untranslated regions. Over expression of miR-218-5p reversed the increased apoptosis and HMGB1 expression observed in HUVECs co-cultured in PBMC supernatant, whereas miR-218-5p knockdown showed the opposite outcomes. Furthermore, the miR-218-5p mimic demonstrated an inhibitory effect on the apoptosis of HUVECs co-cultured in PBMC supernatant, which was reversed by over expression of HMGB1. In HSP rats, over expression of miR-218-5p attenuated HSP and decreased the level of HMGB1.ConclusionsMiR-218-5p attenuated HSP at least partly through regulating HMGB1 expression and affecting the function of HUVECs.
       
  • Relationship Between Clinical Features and Computed Tomographic Findings
           in Hospitalized Adult Patients with Community-Acquired Pneumonia
    • Abstract: Publication date: Available online 3 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Hyewon Seo, Seung-Ick Cha, Kyung-Min Shin, Jae-Kwang Lim, Seung-Soo Yoo, Shin-Yup Lee, Jaehee Lee, Chang-Ho Kim, Jae-Yong Park BackgroundData on the relationship between the clinical and microbiological features of community-acquired pneumonia (CAP) and its computed tomography (CT) findings are limited. The aim of the present study was to investigate the clinic-microbiological features of patients with CAP presenting with ground-glass opacity (GGO) and centrilobular nodules or tree-in-bud pattern on CT images.MethodsPatients with CAP that underwent a CT scan at presentation were retrospectively classified using CT findings into consolidation, GGO, and bronchiolitis groups. These 3 groups were compared in terms of clinical parameters and microbiological data.ResultsForty (2.4%) patients were allocated to the bronchiolitis group and 46 (2.8%) to the GGO group. The most common pathogen in the bronchiolitis group was Mycoplasma pneumoniae, which was significantly more frequently isolated in this group. The bronchiolitis group was characterized by a higher percentage of cough, a lower percentage of chest pain, and lower blood levels of inflammatory markers. Common pathogens in the GGO group were not significantly different from those in the other 2 groups. Unlike that observed in the consolidation group, complicated parapneumonic effusion or empyema was not observed in the bronchiolitis or GGO group. Outcome variables were similar in the 3 groups.ConclusionsThe bronchiolitis group was characterized by a higher frequency of M pneumoniae and a less severe form of CAP. The GGO and consolidation groups was similar with respect to causative microorganisms and the clinical features of CAP. No patient in the bronchiolitis or GGO group exhibited complicated parapneumonic effusion or empyema.
       
  • The King Is Dead: Clark Gable’s Heart Attack
    • Abstract: Publication date: Available online 3 April 2018Source: The American Journal of the Medical SciencesAuthor(s): Robert S. Pinals, Harold Smulyan Clark Gable was born in a small Ohio mining town and never finished high school. Stage struck as a young man, he did menial jobs while working his way up to movie stardom—his most famous role was in “Gone with the Wind.” He married 5 times. During WWII, he enlisted in the Army Air Corps, flew a few combat missions as a gunner and won the Distinguished Service Cross. Personally, he was intermittently obese, a drinker, smoker, hypertensive and predictably in 1960, he suffered an acute myocardial infarction. His clinical course was benign until the 10th hospital day, when he died suddenly. No resuscitation was attempted. At the time of his death, preventive cardiology, mouth-to-mouth ventilation, closed chest cardiac massage, defibrillation and coronary care units were in their infancy. The history of these and subsequent therapeutic practices are reviewed, but Gable died a bit too early for their application.
       
  • Central retinal artery occlusion following hyaluronic acid fillers
           injection
    • Abstract: Publication date: Available online 30 March 2018Source: The American Journal of the Medical SciencesAuthor(s): Ji-long Hao, Om Prakash Pant, Cheng-wei Lu
       
 
 
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