American Journal of Medicine最新文献

{"title":"Treatment of OSA using mandibular advancement versus CPAP in improving cardiovascular health.","authors":"Yi-Hui Ou, Juliana Tereza Colpani, Crystal S Cheong, Weiqiang Loke, As Tar Thant, E Ching Shih, Frank Lee, Siew-Pang Chan, Ching-Hui Sia, Chieh-Yang Koo, Yao-Hao Teo, Justin Chan, Serene Wong, Aiping Chua, Chin-Meng Khoo, William Kf Kong, Calvin W Chin, Pipin Kojodjojo, Philip E Wong, Derek Hausenloy, Mark Y Chan, A Mark Richards, Peter A Cistulli, Chi-Hang Lee","doi":"10.1016/j.amjmed.2026.04.008","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.008","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea is a significant risk factor for hypertension. We assessed the relative effectiveness of mandibular advancement device (MAD) versus continuous Positive Airway Pressure (CPAP) in reducing 24-hour ambulatory blood pressure (BP) and other health-related outcomes over 12 months.</p><p><strong>Methods: </strong>In a randomized, non-inferiority trial, 321 participants with hypertension and increased cardiovascular risk were recruited for polysomnography. Of these, 220 with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥15 events/hour) were randomized to MAD or CPAP (1:1). We report the final outcomes at the 12-month follow-up.</p><p><strong>Results: </strong>A total of 180 participants (MAD: 89; CPAP: 91) completed the 12-month follow-up. Median usage for MAD and CPAP was 5.5 and 4.9 hours per night, respectively. Compared to baseline, the 24-hour mean arterial BP at 12 months decreased by 2.3 mmHg (P=0.200) in the MAD group and by 1.0 mmHg (P=0.999) in the CPAP group. The difference between-groups was -0.6 mmHg (95% confidence interval: -2.53 to 1.39, non-inferiority P<0.019). The MAD group demonstrated a larger reduction in asleep BP compared to the CPAP group. The prevalence of excessive daytime sleepiness in the MAD group decreased from 30.3% at baseline to 10.1% at 12-month follow-up (P=0.001), and from 38.5% to 7.7% in the CPAP group (P<0.001). The between-group difference was 10.6% (P=0.097). No significant within-group or between-group differences were observed in the prevalence of arrhythmias and plasma levels of cardiac biomarkers.</p><p><strong>Conclusion: </strong>At 12-month, MAD is non-inferior to CPAP for reducing 24-hour mean arterial BP in participants with hypertension and increased cardiovascular risk.</p><p><strong>Trial registration: </strong>NCT04119999.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788161","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":"Salt.","authors":"Richard B Weinberg","doi":"10.1016/j.amjmed.2026.04.016","DOIUrl":"10.1016/j.amjmed.2026.04.016","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788166","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":"Differentiating Neurologic Disorders from Spinal Conditions: Evidenced-Based History and Physical Examination Clues for the Orthopedic Clinic.","authors":"Joseph E Nassar, Ashley Knebel, Lama A Ammar, Manjot Singh, Eren O Kuris, Bassel G Diebo, Alan H Daniels","doi":"10.1016/j.amjmed.2026.04.017","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.017","url":null,"abstract":"<p><p>This narrative review highlights neurologic disorders that mimic or worsen degenerative spine disease and provides key clinical clues for recognition in spine surgery practice. A focused review examined amyotrophic lateral sclerosis, normal pressure hydrocephalus, multiple sclerosis, Parkinson's disease, Guillain-Barré syndrome, peripheral neuropathies, and transverse myelitis. These conditions frequently overlap with structural spinal pathology through motor, sensory, and gait disturbances. Amyotrophic lateral sclerosis presents with combined upper and lower motor neuron signs. Normal pressure hydrocephalus is characterized by gait impairment, urinary incontinence, and cognitive decline. Multiple sclerosis often causes relapsing multifocal deficits that do not localize to a single spinal level. Parkinson's disease is identified by bradykinesia, rigidity, tremor, and progressive postural deformity. Other mimics including Guillain-Barré syndrome, small and large fiber neuropathies, and transverse myelitis further complicate evaluation. Careful history and neurologic examination remain central, while disease-specific tools such as the 2017 McDonald criteria and the Dubousset Functional Test improve recognition. Early identification is essential to avoid unnecessary surgery, guide multidisciplinary referral, improve risk stratification, and optimize patient outcomes.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730551","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":"The enemy of good is perfect.","authors":"Joseph S Alpert","doi":"10.1016/j.amjmed.2026.04.020","DOIUrl":"10.1016/j.amjmed.2026.04.020","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730531","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":"New understanding and treatment of adult mitochondrial dysfunction: an example of personalized precision medicine.","authors":"Gabriela R Esnaola, Edward J Goetzl","doi":"10.1016/j.amjmed.2026.04.018","DOIUrl":"10.1016/j.amjmed.2026.04.018","url":null,"abstract":"<p><p>The principal cellular energy-generating pathways of mitochondria used to produce adenosine triphosphate (ATP) are oxidative phosphorylation and β-oxidation of fatty acids. Under anaerobic conditions, glycolysis in the cytoplasm is an alternative mechanism for production of ATP. Mitochondrial diseases result from one or more of the over 350 mutations in mitochondrial DNA (10%) or nuclear DNA (90%) that cause defective mitochondrial ATP production. The most common manifestations in adults with mitochondrial DNA mutations are diminished vision, myopathy, cardiomyopathy, neuropathy, encephalopathy and diabetes. Uncommonly there are stroke-like syndromes. The most common manifestations in adults with nuclear DNA mutations are neuropathy with prominent ataxia, ophthalmoplegia, dysarthria, myopathy, cardiomyopathy, liver disease, neuroendocrine and renal cell tumors, and hypoglycemia. Adults, especially the elderly, may only develop manifestations in the course of stressful illnesses that unmask these mutations. Children may require mitochondrial transfer or gene editing therapy. These mutations should be sought in leukocytes or muscle tissue in adults who do not respond to usual treatment for severe stressful illnesses as they may benefit from newly-approved medications.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724264","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":"The effect of SGLT-2 inhibitors on portal hypertensive complications and mortality in patients with cirrhosis.","authors":"Abhinav K Rao, Ahmed Ibrahim, Don C Rockey","doi":"10.1016/j.amjmed.2026.04.019","DOIUrl":"10.1016/j.amjmed.2026.04.019","url":null,"abstract":"<p><strong>Introduction: </strong>We hypothesized that SGLT-2 inhibitors (SGLT-2is) may have beneficial effects on portal hypertension in patients with cirrhosis.</p><p><strong>Methods: </strong>Using TriNetX, we identified adults with cirrhosis treated with SGLT-2is. Patients prescribed SGLT-2is within 12 months of a cirrhosis diagnosis were examined (vs. no treatment). Three subgroups were examined: MASH cirrhosis, alcohol-associated cirrhosis, and \"other\" cirrhosis. To control for liver disease severity/etiology, propensity score matching (PSM) incorporating 47 variables was performed within each subgroup.</p><p><strong>Results: </strong>PSM resulted in a total of 10,976 cirrhosis patients (compensated and decompensated together; 5488 each SGLT-2i/control), composed of three matched subgroups (MASH (6052); alcohol (2864); other (2060)). After matching, baseline characteristics were similar in patients prescribed SGLT-2is and controls. Patients receiving SGLT-2is developed significantly fewer new portal hypertensive complications, including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome (any portal hypertensive complication risk; MASH: HR 0.73, 95%CI 0.64-0.83; alcohol: HR 0.58, 95%CI 0.49-0.68; other: HR 0.60, 95%CI 0.47-0.76; all P < 0.001). The complication with the greatest reduction was ascites. In sensitivity analyses of decompensated cirrhosis patients, the development of a new portal hypertension complication was lower in those prescribed SGLT-2is. Patients prescribed SGLT-2is had a reduced risk of all-cause mortality (MASH: HR 0.57, 95%CI 0.49-0.66; alcohol: HR 0.65, 95%CI 0.55-0.77; other: HR 0.49, 95%CI 0.39-0.62; all P < 0.001).</p><p><strong>Conclusion: </strong>Cirrhosis patients prescribed SGLT-2is had decreased portal hypertensive complications and increased survival compared to those not receiving SGLT-2is.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724338","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":"Patient Health or Corporate Profits - Shouldn't the Former Come First?","authors":"James A Reiffel, Gerald V Naccarelli, Peter R Kowey","doi":"10.1016/j.amjmed.2026.04.011","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.011","url":null,"abstract":"<p><p>In June 2025, the End Prescription Drug Ads Now Act, introduced by Senators Sanders and King, noted concerns regarding direct to consumer (DTC) advertising and called for its abolition. DTC advertising for pharmaceuticals adversely drives up costs for prescription medications and also leads to time wastage for busy physicians. However, the Act did not address the supplement market of which there are now over 95,000 products for which DTC ads are also common despite the fact that evidence suggests that the majority do not work, are of uncertain value, or do not have significant scientific support. Additionally, some have been sanctioned for making false claims; some have significant mislabeling; some have resulted in hospitalizations; and several have had contaminants. Supplements are approved by the FDA as foods, rather than as medications, an entirely different and less rigorous process. Yet many are not advertised as foods nor do patients treat them as such. We believe the supplement approval process as well as DTC advertising for all pharmaceuticals should be reevaluated. Our manuscript below provides more details.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718944","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":"Proliferative myositis: An intramuscular lesion requiring no special clinical intervention.","authors":"Yanmei He, Xiaodong Zhang","doi":"10.1016/j.amjmed.2026.04.006","DOIUrl":"10.1016/j.amjmed.2026.04.006","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718997","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":"Lifetime management of aortic stenosis: a primer for the generalist.","authors":"Nawaz Z Safdar, Tarek Khedro, Sabir A Khan, Aarish H Khan, David Goldberg, Paul N Fiorilli, Sheldon Goldberg","doi":"10.1016/j.amjmed.2026.04.010","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.010","url":null,"abstract":"<p><p>Aortic stenosis affects millions globally and untreated disease approaches a one-year mortality of 50%. While surgical aortic valve replacement (SAVR) was historically the only life-prolonging treatment, transcatheter aortic valve replacement (TAVR) has revolutionized management, initially for inoperable patients and now extending to lower-risk populations. This review provides an overview of aortic stenosis, from pathophysiology through diagnosis. Disease progression, emerging pharmacological therapies, and surveillance strategies are discussed. Finally, the approach to intervention has evolved from surgical risk-based decision-making to a framework centered on age, life expectancy, and valve durability. Timely recognition and referral to a multidisciplinary heart team remain essential for shared decision making.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718939","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":"Elderly-onset seronegative inflammatory arthritis: a narrative review and practical approach.","authors":"Isaac K S Ng, Ainsley R Y B Lee, Kar Mun Chong, Desmond B Teo, Li Feng Tan, Charlotte S L Tan","doi":"10.1016/j.amjmed.2026.04.013","DOIUrl":"10.1016/j.amjmed.2026.04.013","url":null,"abstract":"<p><p>Elderly-onset seronegative inflammatory arthritis encompasses a heterogenous group of inflammatory joint disorders presenting in older adults (>60 years) in the absence of rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies. Its recognition is increasingly important in a rapidly aging global population in whom seronegative disease is more common. In older adults, immune senescence, inflammaging and multimorbidity may alter disease phenotype and complicate diagnosis and management. Careful clinical evaluation of nature and distribution of joint pains, constitutional, extra-articular/systemic features and patient-specific risk factors, with adjunctive laboratory, imaging and joint fluid analyses is necessary to distinguish diagnostic mimics. In this article, we describe the common causes of elderly-onset seronegative inflammatory arthritis and describe a practical diagnostic approach and treatment framework for such cases. In elderly persons, management should be tailored to the patient's premorbid health, functional status and goals-of-care, to balance therapeutic benefit with vulnerability to adverse effects such as glucocorticoid toxicity, immunosuppression-related infections and cytopenias. A \"start low, go slow\" approach to glucocorticoids and disease-modifying antirheumatic drugs based on shared decision-making on established treatment goals is recommended in frail older adults.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718927","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}