American Journal of Medicine最新文献

{"title":"From obesity to cardiovascular disease: pathological basis and clinical implications.","authors":"Matteo Nardin, Roxana Mehran, Angelo Oliva, Elvin Kedhi, Gennaro Galasso, Simone Nardin, Stefano Savonitto, Gianluigi Condorelli, Giuseppe De Luca","doi":"10.1016/j.amjmed.2026.04.041","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.041","url":null,"abstract":"<p><p>Obesity is a major global health burden with profound cardiovascular implications, contributing to morbidity, mortality, and healthcare costs. Excess adiposity promotes atherosclerosis, hypertension, atrial fibrillation, heart failure, stroke, and venous thromboembolism through entangled mechanisms, including adipose tissue dysfunction, chronic low-grade inflammation, immune dysregulation, endothelial impairment, insulin resistance, and neurohormonal activation. Dysfunctional adipose tissue, including perivascular and epicardial fat, actively contributes to vascular inflammation, cardiac remodeling, and arrhythmogenesis. Although the \"obesity paradox\" has been described, obesity remains strongly associated with earlier and more severe cardiovascular events. Recent therapeutic advances, particularly incretin therapies, have improved the management of obesity and its consequences by realizing notable weight loss and metabolic benefits. However, important gaps in obesity phenotyping, cardiovascular risk stratification, and individualized therapy persist, supporting integrated precision-medicine and public-health strategies to reduce obesity-related cardiovascular burden.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain fry: Navigating the cognitive burden of artificial intelligence implementation in healthcare.","authors":"A M Hopkins, B D Menz, S Bacchi, A Rowland","doi":"10.1016/j.amjmed.2026.04.038","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.038","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Calcific Tendinitis of the Longus Colli Mimicking Retropharyngeal Infection.","authors":"Yi Ding, Xiaodong Zhang","doi":"10.1016/j.amjmed.2026.04.036","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.036","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of salt-sensitive hypertension in clinical settings: how should we approach it?","authors":"Irakli Todua","doi":"10.1016/j.amjmed.2026.05.003","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.05.003","url":null,"abstract":"<p><p>Salt sensitivity is a major component of highly prevalent uncontrolled hypertensive disease. Multiple disease determinants, such as age, sex, genetic predisposition, pro-inflammatory factors, renal and vascular dysfunction, disrupted blood-brain barrier integrity, as well as gut microbiome health, effectively regulate sodium turnover and associated adverse outcomes. Salt sensitive blood pressure can be commonly observed in patients with both primary and secondary hypertension. Furthermore, patients suffering from obesity and insulin-resistant states, heart failure, chronic kidney disease, as well post-menopausal females and senior citizens, may be particularly sensitive to excessive salt exposure. Despite paramount importance, diagnosis or treatment of salt sensitive blood pressure remain challenging, often pushing clinicians into complicated management labyrinths. Significant discordance between objective findings, such as degree of thirst and edema on presentation, and results of laboratory testing, such as serum sodium, potassium, NT-proBNP, or RAAS essay, is often observed delaying the provision of appropriate care. This review offers detailed description of underlying pathophysiology, diagnosis and treatment of salt sensitive blood pressure in clinical settings, intending to ameliorate the burden of uncontrolled hypertension.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse Soft Tissue Calcifications in ESRD-Associated Calciphylaxis.","authors":"Daniel Guttman, Scott Schafler","doi":"10.1016/j.amjmed.2026.04.029","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.029","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating Apolipoprotein E concentration and incident cardiovascular diseases: evidence from an electronic health record-based cohort.","authors":"Xia Li, Shuang Wang, Jiangshui Wang, Yinze Ji, Li He, Chunbao Mo, Shiyuan Ge, Jing Zheng, Fengchao Liang, Dongfeng Gu","doi":"10.1016/j.amjmed.2026.04.031","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.031","url":null,"abstract":"<p><strong>Background: </strong>Circulating Apolipoprotein E (ApoE) plays key roles in lipoprotein metabolism, but its clinical utility in cardiovascular risk assessment and its relationship with incident heart failure remain unclear. This study aims to evaluate the association of serum ApoE concentration with incident cardiovascular outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study used electronic health records from a multi-specialty outpatient population in Shenzhen, China. Adults who had serum ApoE measured and did not have prior ischemic heart disease, stroke, or heart failure were included (N=14,852). The outcomes were incident major adverse cardiovascular events (MACE), ischemic heart disease, stroke, and heart failure. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models.</p><p><strong>Results: </strong>During a median follow-up of 4.0 years, we observed 491 MACE, 515 ischemic heart disease, 293 stroke, and 181 heart failure incident events. Higher ApoE concentrations were significantly associated with increased risks of incident MACE (HR[95%CI] per 1mg/dL increment: 1.09[1.04-1.15]), ischemic heart disease (1.07[1.02-1.13]), and heart failure (1.14[1.07-1.22]), but not stroke (1.03[0.96-1.11]). These associations were independent of low-density lipoprotein cholesterol (LDL-C), small and dense LDL-C, high-density lipoprotein cholesterol, and neutrophil-to-lymphocyte ratio. However, adjustment for triglycerides attenuated the associations. Individuals with elevations in both ApoE and triglycerides had disproportionately higher risks of cardiovascular events.</p><p><strong>Conclusions: </strong>Elevated circulating ApoE concentrations are risk factors for incident MACE, ischemic heart disease, and heart failure, and may signal the residual risk of cardiovascular disease beyond cholesterol markers. Concurrent elevation in ApoE and triglycerides may represent a high-risk clinical phenotype, suggesting the joint assessment of ApoE and triglycerides may improve risk stratification for hypertriglyceridemic individuals.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study of the usefulness of pleural effusion and blood indicators and ratios in detecting benign and malignant pleural effusion.","authors":"Dan Chen, Fengying Jiang, Qingyang Liu, Qiubo Wang","doi":"10.1016/j.amjmed.2026.05.001","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.05.001","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify markers and ratios in serum and pleural fluid that could accurately differentiate between benign and malignant pleural effusion.</p><p><strong>Methods: </strong>A total of 251 patients with pleural effusion were enrolled. 49 patients had a clinical diagnosis of cancer (malignant group), while 202 patients had benign lesions (benign group). Relevant pleural and serum biomarkers were measured. Multivariate logistic regression and receiver operating characteristic curve analysis were conducted to discover significant indicators and ratios.</p><p><strong>Results: </strong>Univariate analysis revealed significant differences in multiple parameters between the two groups. Multivariate analysis identified pleural fluid lactate dehydrogenase, total protein, adenosine deaminase, and glucose as the most valuable indicators for distinguishing malignant from benign pleural effusion (p < 0.05). The ratios of pleural fluid total protein to serum adenosine deaminase and pleural fluid lactate dehydrogenase to serum adenosine deaminase exhibited optimal diagnostic efficiency, with area under the curve (AUC) values of 0.833 and 0.802, respectively. At cut-off values of 3.34 and 19.87, the two ratios yielded sensitivities of 79.59% and 81.63% and specificities of 72.00% and 71.00% for malignant pleural effusion.</p><p><strong>Conclusion: </strong>The two ratios discussed above serve as valuable diagnostic markers for distinguishing malignant pleural effusion from benign pleural effusion.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the Room Began Listening.","authors":"Yusuke Shono","doi":"10.1016/j.amjmed.2026.04.033","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.033","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding-Related Interactions Between DOACs and Cardiovascular Drugs: Insights from FDA adverse event reporting system.","authors":"Seunghyun Cheon, Yu-Seon Choi, Young Seo Kim, Jee-Eun Chung","doi":"10.1016/j.amjmed.2026.05.004","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.05.004","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving direct-oral anticoagulants (DOACs) often have multiple cardiovascular disorders and are frequently exposed to polypharmacy. This study aimed to identify bleeding-related drug interactions between DOACs and cardiovascular drugs in the context of polypharmacy using the FDA Adverse Event Reporting System (FAERS).</p><p><strong>Methods: </strong>Individual case safety reports involving apixaban, dabigatran, edoxaban, or rivaroxaban were extracted from FAERS. DOAC-related reports were classified according to exposure to concomitant use of predefined 15 drug classes of interest-ten cardiovascular drug classes, three classes of pharmacokinetic modifiers, anti-platelets, and non-steroidal anti-inflammatory drugs-and bleeding events. Bleeding events were defined at three levels: haemorrhage-related events, actual bleeding events, and major bleeding. Major bleeding was further classified by anatomical site. Exact matching and logistic regression were performed to estimate adjusted reporting odds ratios.</p><p><strong>Results: </strong>A total of 317,583 eligible reports were included. Fifteen DOAC-drug combinations were consistently identified as significant interaction signals across the three bleeding definitions, with adjusted RORs ranging from 1.06 to 2.36. Diuretics showed consistent interaction signals across DOACs and bleeding definitions, while the strongest interaction signals were observed with digitalis glycosides, non-dihydropyridine calcium channel blockers, and amiodarone analogs. Site-stratified major bleeding analyses identified 64 significant interaction signals, with rivaroxaban accounting for the largest proportion, whereas edoxaban showed a relatively less extensive interaction signal profile.</p><p><strong>Conclusions: </strong>These findings suggest that consideration of polypharmacy and potential drug interactions may improve DOAC selection and risk stratification, particularly with concomitant cardiovascular drugs and site-specific bleeding risk, supporting closer monitoring.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent Advanced Hepatic Fibrosis in Asymptomatic Pulmonary Sarcoidosis.","authors":"Readon Teh, Phang Kee Fong","doi":"10.1016/j.amjmed.2026.04.028","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.028","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}