American Journal of Medicine最新文献

{"title":"Hidden in Plain Sight: When Adrenal Insufficiency Looks Like Hypothyroidism.","authors":"Gholam R Pishdad, Parisa Pishdad","doi":"10.1016/j.amjmed.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.004","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031287","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":"Socioeconomic Deprivation, Unhealthy Lifestyle, and Premature Mortality in Patients With Type 2 Diabetes: A Population-Based Longitudinal Study.","authors":"Jie Li, Jiang Li, Yanqi Fu, Kun Zhang, Xiao Tan, Ningjian Wang, Lu Qi, Yingli Lu, Bin Wang","doi":"10.1016/j.amjmed.2025.05.001","DOIUrl":"10.1016/j.amjmed.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>Adverse health behaviors have been found to play a role in linking socioeconomic deprivation and mortality, but relevant evidence in patients with type 2 diabetes is lacking. We aimed to quantify the mediation effect of overall lifestyles on the association between socioeconomic deprivation and premature mortality as well as the interaction of deprivation and lifestyle in diabetes.</p><p><strong>Methods: </strong>This cohort study included 20,463 UK Biobank participants with type 2 diabetes at recruitment between 2006 and 2010. Socioeconomic deprivation level was determined using the Townsend deprivation index. An overall lifestyle score was constructed based on 6 health behaviors including smoking, alcohol consumption, physical activity, diet, sleep duration, and television viewing time. Cox proportional hazards models were employed to investigate the associations of socioeconomic deprivation and lifestyle with premature mortality.</p><p><strong>Results: </strong>Over a mean follow-up of 7.4-12.7 years, 3381, 2382, 1281, and 577 patients with diabetes died before ages 80, 75, 70, and 65 years, respectively. High socioeconomic deprivation showed an association with a higher risk of premature mortality that was partially mediated by overall lifestyles. A significant interaction was found between lifestyle and deprivation on premature mortality, which became more apparent as age at death decreased. The adjusted hazard ratio (HR) for death before age 80 years when comparing the unfavorable versus favorable lifestyle was 1.49 (95% CI 1.21-1.82) in the least deprived group and 1.92 (1.56-2.36) in the most deprived group. Equivalent HRs for death before age 65 years were 1.33 (0.76-2.33) and 3.78 (2.04-7.02), respectively.</p><p><strong>Conclusions: </strong>In patients with type 2 diabetes, unhealthy lifestyles mediated the association between socioeconomic deprivation and premature mortality and conferred disproportionate risk of premature mortality in more deprived groups.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042559","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":"Effects of Collagen Supplements on Skin Aging: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Seung-Kwon Myung, Yunseo Park","doi":"10.1016/j.amjmed.2025.04.034","DOIUrl":"10.1016/j.amjmed.2025.04.034","url":null,"abstract":"<p><strong>Background: </strong>Collagen supplements are promoted to help aging skin. However, no meta-analysis of randomized controlled trials (RCTs) has examined their effects by funding source and study quality, which may influence outcomes.</p><p><strong>Methods: </strong>PubMed, Embase, and Cochrane Library were searched from inception to June 14, 2024.</p><p><strong>Results: </strong>A total of 23 RCTs with 1474 participants were analyzed. In a meta-analysis of all 23 RCTs, collagen supplements significantly improved skin hydration, elasticity, and wrinkles. However, in the subgroup meta-analysis by funding source, studies not receiving funding from pharmaceutical companies revealed no effect of collagen supplements for improving skin hydration, elasticity, and wrinkles, while those receiving funding from pharmaceutical companies did show significant effects. Similarly, high-quality studies revealed no significant effect in all categories, while low-quality studies revealed a significant improvement in elasticity.</p><p><strong>Conclusions: </strong>There is currently no clinical evidence to support the use of collagen supplements to prevent or treat skin aging.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997559","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":"Reduced Left Ventricular Apical Rotation: A Novel Pathophysiological Correlate Underlining Acute Ischemic Mitral Regurgitation.","authors":"Shachar Kadosh, Nadav Balkin, Shemy Carasso, Itshak Amsalem, Elad Asher, Michael Glikson, Arik Wolak, Tal Hasin","doi":"10.1016/j.amjmed.2025.04.036","DOIUrl":"10.1016/j.amjmed.2025.04.036","url":null,"abstract":"<p><strong>Background: </strong>Functional mitral regurgitation (or backward flow to the left atrium with an anatomically normal valve) is associated with adverse outcomes, yet its pathophysiology is not fully understood. We set out to investigate the association between reduced apical rotation and functional mitral regurgitation in patients presenting with first acute ST-elevation myocardial infarction.</p><p><strong>Methods: </strong>Retrospective analysis of first echocardiographic images for patients with first acute ST-elevation myocardial infarction undergoing percutaneous coronary intervention from July 2019 to October 2022. Patients with significant (moderate or worse) functional mitral regurgitation were compared to those with less functional mitral regurgitation for baseline characteristics, myocardial infarction parameters, and myocardial features including apical rotation. Logistic regression analyses were performed to assess determinants of functional mitral regurgitation.</p><p><strong>Results: </strong>Of the 200 initially identified subjects, 164 were included in the final analysis. Significant functional mitral regurgitation was observed in 14 patients (8.5%). Reduced apical rotation was significantly associated with functional mitral regurgitation (2.2 ± 1.7° compared with 5.7 ± 3.3°, P < .001), independent of other variables. Other echocardiographic findings in patients with significant functional mitral regurgitation were mildly reduced ejection fraction (43% ± 10% vs 48% ± 8%, P = .010), mildly enlarged left ventricular diameter (5.1 ± 0.5 cm vs 4.8 ± 0.5 cm, P = .022), and enlarged left atrial diameter (4.2 ± 0.5 cm vs 3.8 ± 0.4 cm, P = .004). In an adjusted model including clinically relevant variables, the probability of significant acute functional mitral regurgitation increased by 2.14 (95% confidence interval 1.35-3.40, P = .001) for every degree decrease in apical rotation.</p><p><strong>Conclusion: </strong>This study highlights for the first time a significant correlation between reduced apical rotation and acute post- ST-elevation myocardial infarction functional mitral regurgitation, posing a possible novel pathophysiological mechanism.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023925","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":"Cannabis Use is Associated with Less Peripheral Inflammation but Similar Insulin Sensitivity as Nonuse in Healthy Adults.","authors":"Angela D Bryan, Carillon J Skrzynski, Gregory Giordano, Jinqiu Yang, Madeline Stanger, L Cinnamon Bidwell, Kent E Hutchison, Leigh Perreault","doi":"10.1016/j.amjmed.2025.05.002","DOIUrl":"10.1016/j.amjmed.2025.05.002","url":null,"abstract":"<p><strong>Background: </strong>This study tested whether cannabis affects inflammation and insulin sensitivity and if this varied based on THC:CBD ratios. Participants who currently used cannabis were assigned to use one of 3 cannabis flower products ad libitum for 4 weeks and compared to nonusing participants.</p><p><strong>Methods: </strong>Healthy participants 21 to 40 years old without diabetes were included. Participants had to engage in ≥ weekly cannabis use for ≥ one year (cannabis use groups) or no cannabis use in the past year (cannabis nonuse group). Participants who used cannabis purchased and used a THC-dominant (23% THC, 0% CBD), THC+CBD (10% THC, 8% CBD), or CBD-dominant product (20% CBD, 1% THC). Peripheral inflammation was assessed with several cytokines (TNF-α, IL-1β, IL-4, IL-6, IL-12, IFNG, IL10) and one chemokine (MCP-1). Insulin sensitivity was assessed via the Matsuda Index.</p><p><strong>Results: </strong>Models were intent-to-treat and utilized maximum likelihood estimation. Cannabis use was associated with lower peripheral inflammation (P < .001) than nonuse. THC:CBD ratio of products used over 4 weeks did not change peripheral inflammation levels nor affect insulin sensitivity compared to nonuse.</p><p><strong>Conclusions: </strong>Habitual cannabis use (vs. nonuse) is associated with lower peripheral inflammation with no difference in insulin sensitivity in metabolically healthy, young people.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020329","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":"Antidepressant Trial Duration Versus Duration of Real-World Use: A Systematic Analysis.","authors":"William Ward, Alyson Haslam, Vinay Prasad","doi":"10.1016/j.amjmed.2025.04.037","DOIUrl":"10.1016/j.amjmed.2025.04.037","url":null,"abstract":"<p><strong>Background: </strong>Antidepressant use is rising globally, with increasing duration of real-world prescribing. While the FDA considers 6-8 week trials adequate for regulatory approval, guidelines recommend prolonged treatment, raising questions about evidence supporting long-term prescribing practices.</p><p><strong>Methods: </strong>This descriptive review analyzed 52 placebo-controlled randomized trials (n = 10,116) of the 10 most commonly prescribed antidepressants, sampled at 5-year intervals (1978-2023). We compared trial durations with real-world usage patterns from the National Health and Nutrition Examination Survey and assessed methodological characteristics including standardized scales, withdrawal monitoring, and taper protocols.</p><p><strong>Results: </strong>The median duration of antidepressant use in the United States was approximately 5 years, while the median trial duration was 8 weeks (IQR: 6-12 weeks). Among trials, 88.5% (n = 46) lasted ≤12 weeks, 11.5% (n = 6) randomized participants beyond 12 weeks, and none exceeded 52 weeks. Few trials monitored withdrawal symptoms (3.8%), included taper protocols (18.9%), or reported post-treatment outcomes (1.9%).</p><p><strong>Conclusions: </strong>A substantial discordance exists between the typical 8-week duration of clinical trials and the median 5-year real-world use of antidepressants. This gap, compounded by inadequate monitoring for withdrawal effects and post-treatment outcomes, raises important questions about the evidence supporting current long-term prescribing practices. Publicly funded trials of longer duration that include monitoring for withdrawal and relapse are necessary to determine optimal antidepressant therapy duration.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059860","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":"Longitudinal Clinical Outcomes and Mortality from Steatotic Liver Disease: A Meta-Analysis.","authors":"Do Han Kim, Donghyun Ko, Pojsakorn Danpanichkul, Glenn Jun Kit Ho, Faith Xin Ning Tan, N Apoorva Sasikumar, Ethan Kai Jun Tham, Daniel Q Huang, Nicholas Syn, Ming-Hua Zheng, Takumi Kawaguchi, Yoshio Sumida, Atsushi Nakajima, Hirokazu Takahashi, Mazen Noureddin, Cheng Han Ng, Mark D Muthiah, Karn Wijarnpreecha","doi":"10.1016/j.amjmed.2025.04.027","DOIUrl":"10.1016/j.amjmed.2025.04.027","url":null,"abstract":"<p><strong>Introduction: </strong>The updated consensus introduces \"steatotic liver disease\" as an umbrella term for all patients with hepatic steatosis, with specific subtypes such as metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD with moderate alcohol intake), and alcohol-associated liver disease. Understanding the characteristics and long-term outcomes of these subtypes is essential.</p><p><strong>Methods: </strong>A systematic review and meta-analysis examined studies published between January 2023 and August 2024 in MEDLINE and EMBASE on liver-related events, cardiovascular outcomes, and mortality across steatotic liver disease subtypes.</p><p><strong>Results: </strong>A total of 13 studies, involving 17.6 million patients were included. Of these, 6.8 million individuals were diagnosed with steatotic liver disease. Subtype analysis revealed a significant increase in liver-related events and composite cardiovascular outcomes across all steatotic liver disease subtypes compared to non-steatotic liver disease. Patients with MetALD and alcohol-associated liver disease were associated with a higher risk of all-cause mortality when compared to non-steatotic liver disease. Compared to MASLD, patients with MetALD and alcohol-associated liver disease significantly elevated the risk of liver-related events and individuals with alcohol-associated liver disease were associated with increased risk of all-cause mortality. Sensitivity analysis demonstrated that certain mortality outcomes were no longer significant.</p><p><strong>Conclusion: </strong>Individuals across steatotic liver disease face an elevated risk of liver-related events, liver cancer, and cardiovascular outcomes. For liver-related events, the risk is progressively higher across MASLD, MetALD, and alcohol-associated liver disease, respectively. Misclassification may be introduced when using different diagnostic methods, leading to changes in outcomes. These findings validate the impact of the new classification in predicting outcomes.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994623","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":"Stroke Percussion: A Gentle and Reproducible Bedside Technique for Defining Organ Borders.","authors":"J Kelly Smith","doi":"10.1016/j.amjmed.2025.04.026","DOIUrl":"10.1016/j.amjmed.2025.04.026","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037977","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":"Immunizations, Autism, and Statistical Analysis.","authors":"Jose A Vazquez, Arni S R Srinivasa Rao","doi":"10.1016/j.amjmed.2025.04.022","DOIUrl":"10.1016/j.amjmed.2025.04.022","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054828","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":"Cardiac Biomarkers for the Prediction, Discrimination, and Risk-Stratification of Type 2 Myocardial Infarction: A Critical Appraisal.","authors":"Daniel L Pollmann, Jonathan D Knott, Pedro E P Carvalho, Fred S Apple, Allan S Jaffe, Yader Sandoval","doi":"10.1016/j.amjmed.2025.04.024","DOIUrl":"10.1016/j.amjmed.2025.04.024","url":null,"abstract":"<p><p>Distinguishing between myocardial infarction caused by atherothrombotic (type 1) and non-atherothrombotic (type 2) etiologies is a frequently encountered and clinically important distinction. This review provides a critical appraisal of studies addressing the use of cardiac biomarkers in type 2 myocardial infarction for a) discrimination, b) prediction, and c) risk-stratification. No single biomarker thus far provides robust performance for these purposes. There are efforts, however, at combining multiple biomarkers in stepwise models with or without additional clinical features, as well as novel biomarker approaches to improve performance.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023924","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}