American Journal of Medicine最新文献

{"title":"Pharmacogenomics: Clinical Progress.","authors":"Joseph S Alpert, Qin M Chen, Oleh Alex Mulyar, Tushar Acharya, Olivia Hung, Iniya Rajendran, Jan Lim, Ryan Freeman, Larissa Fedorova","doi":"10.1016/j.amjmed.2025.06.019","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.019","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512688","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":"Impact of Atherosclerotic Conditions and Cardiovascular Medications on Abdominal Aortic Aneurysm Growth.","authors":"Fahad Alkhalfan, Essa Hariri, Anu Aggarwal, Robert Burton, Bhairavi Rajasekar, Alliefair Scalise, Pulkit Chaudhury, Natalia Fendrikova Mahlay, A Phillip Owens, Scott J Cameron","doi":"10.1016/j.amjmed.2025.06.040","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.040","url":null,"abstract":"<p><strong>Background: </strong>While risk factors for atherosclerotic diseases and abdominal aortic aneurysms overlap, some risk factors, like diabetes, may slow aneurysm growth. The impact of atherosclerosis and its treatment on aneurysm growth is unknown. We aimed to investigate whether atherosclerotic conditions and cardiovascular medications are associated with faster aneurysm growth.</p><p><strong>Methods: </strong>Annualized abdominal aortic aneurysm growth rates were assessed over 10 years. The presence of coronary artery disease, peripheral artery disease, renal artery stenosis, and internal carotid artery stenosis was ascertained from vascular studies. Multivariable logistic regression models assessed the association between atherosclerotic conditions and fast aneurysm growth (≥0.5 cm/year). We further stratified by medication use, including aspirin.</p><p><strong>Results: </strong>Coronary artery disease, carotid artery stenosis, and renal artery stenosis were associated with reduced odds of fast aortic aneurysm growth, likely due to medications for treating these conditions. Aspirin was the only medication to show slower aneurysm growth regardless of disease co-morbidity. Patients with peripheral artery disease not managed by medications had faster aneurysm growth than those without peripheral artery disease. The addition of a Statin mediction was associated with a further reduction if fast aneurysm growth in patients with peripheral artery disease already taking aspirin.</p><p><strong>Conclusion: </strong>Atherosclerosis in vascular beds outside of the aorta was associated with a lower risk of fast aneurysm growth. Peripheral artery disease without pharmacological therapy had higher rates of fast aneurysm growth. Aspirin showed decreased aneurysm growth regardless of the co-incident vascular disease in patients with aortic aneurysms, highlighting the importance of appropriate pharmacological therapy.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512685","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 Clinician's Guide to Ethical Challenges in Discharge Planning: Proportionality, Risk, and Justice.","authors":"George Chengxi Bao, Sydney Katz, Debjani Mukherjee, Ezra Gabbay","doi":"10.1016/j.amjmed.2025.06.032","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.032","url":null,"abstract":"<p><p>Discharge planning often presents clinicians with ethical dilemmas. Because most clinicians lack formal training in ethics or have limited access to ethics consultation, we propose a pragmatic framework to address them. Our recommendations are based on a review of PubMed articles on ethics and adult inpatient discharge planning from January 2000 to May 2025. Ethical challenges can be categorized into two principal types: autonomy-related challenges, which arise when patients reject the clinical team's recommendations for safe discharge, and distributive justice-related challenges, which occur when resource allocation constraints affect discharge planning. Possible solutions emerge when applying the principle of proportionality to find a correct balance between the competing ethical principles of autonomy, beneficence, nonmaleficence, and justice. Such balance is inherently subjective, context-dependent, and arrived at through shared, deliberative decision-making. Finding proportionate balance is also error-prone, requiring continual reassessment through a reflective process that recognizes biases from healthcare policy and economic drivers.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509279","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":"\"Old Age Is Always 15 Years Older Than I Am\" ¹.","authors":"Joseph S Alpert","doi":"10.1016/j.amjmed.2025.06.020","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.020","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509278","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":"Calculous acute cholecystitis eliciting umbilical pain: Running head: Calculous acute cholecystitis.","authors":"Takahiro Kobayashi, Yosuke Ono, Nobutaka Hirooka","doi":"10.1016/j.amjmed.2025.06.028","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.028","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509281","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":"Asymptomatic torus mandibularis.","authors":"Yohei Masuda, Masao Horiuchi, Eiji Hiraoka","doi":"10.1016/j.amjmed.2025.06.029","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.029","url":null,"abstract":"<p><p>None.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509280","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":"SGLT2 Inhibitors and Cardiovascular Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Retrospective Cohort Study.","authors":"Hoang Nhat, Ramzi Ibrahim, Rama Mouhaffel, Mahmoud Abdelnabi, Nazli Begum Ozturk, Amany Elshaer, Eiad Habib, Juan Farina, Chadi Ayoub, Justin Z Lee, Anwar Chahal, Kwan Lee, Reza Arsanjani, Amitoj Singh","doi":"10.1016/j.amjmed.2025.06.039","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.039","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent global health issue associated with increased cardiovascular risk. SGLT2 inhibitors offer cardioprotective benefits and may improve MASLD-related outcomes. We aimed to investigate the association between SGLT2 inhibitors use and cardio-hepatic events in patients with MASLD.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Network, including 1,280,057 adults (≥18 years) with MASLD without prior alcohol-associated liver disease between 2014 and 2022. Patients were stratified by SGLT2 inhibitors use. Propensity score matching (1:1, PSM) was performed to balance baseline characteristics between two cohorts. Hazard ratio (HR) with 95% confidence intervals (CIs) were calculated using Cox proportional hazard models.</p><p><strong>Results: </strong>After PSM, there were 69,970 patients with MASLD per each cohort. Mean follow-up was 3.70±2.08 and 4.14±2.66 years for SGLT2 inhibitor users and non-users, respectively. SGLT2 inhibitor use was associated with lower all-cause mortality (HR 0.600 [95% CI, 0.580-0.621]) and hospitalization (HR 0.788 [0.777-0.800]). Cardiovascular benefits included reduced risks of acute heart failure exacerbation (HR 0.872 [0.849-0.896]), acute myocardial infarction (HR 0.916 [0.882-0.952]), cerebral infarction (HR 0.954 [0.916-0.994]), and cardiac arrest (HR 0.661 [0.609-0.718]). Hepatic outcomes showed lower risks of acute liver failure (HR 0.704 [0.643-0.770]) and cirrhosis (HR 0.898 [0.861-0.936]). Safety analysis revealed a lower incidence of acute kidney injury (HR 0.797 [0.779-0.816]) without significant difference for hypoglycemia (HR 0.963 [0.914-1.014]).</p><p><strong>Conclusions: </strong>SGLT2 inhibitors in MASLD patients were associated with reduced mortality, hospitalization, cardiovascular events, and liver complications, highlighting potential benefits beyond glycemic control.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509282","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 Contemporary Nocebo Effect.","authors":"Joseph S Alpert","doi":"10.1016/j.amjmed.2025.06.022","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.022","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486840","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":"Petechial Rash: Coinfection with Rubella and Epstein-Barr Viruses.","authors":"Yoshihito Mima, Masako Yamamoto, Ken Iozumi","doi":"10.1016/j.amjmed.2025.06.016","DOIUrl":"10.1016/j.amjmed.2025.06.016","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310782","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":"Primary Extraskeletal Ewing Sarcoma of the Penis.","authors":"Caijun Huang, Caihong Wang, Ming Lu, Jiawei Wang, Xin He","doi":"10.1016/j.amjmed.2025.06.015","DOIUrl":"10.1016/j.amjmed.2025.06.015","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310783","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}