American Journal of the Medical Sciences最新文献

{"title":"Predictive value of HIF-1α for left ventricular remodeling following an anterior ST-segment elevation myocardial infarction","authors":"Jun Wan MM ,&nbsp;Feng Xu MM ,&nbsp;Chunlin Yin MD ,&nbsp;Yang Jiang MM ,&nbsp;Cai Chen MM ,&nbsp;Yulin Wang MM ,&nbsp;Heping Zuo MM ,&nbsp;Jinglin Cheng MM ,&nbsp;He Li MD","doi":"10.1016/j.amjms.2024.11.009","DOIUrl":"10.1016/j.amjms.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Hypoxia-inducible factor-1α (HIF-1α) has an essential role in ventricular remodeling processes involving myocardial fibrosis and hypertrophy, but the clinical significance of HIF-1α levels in the early period after ST-segment elevation myocardial infarction (STEMI) for the prediction of left ventricular remodeling (LVR) has yet to be fully elucidated.</div></div><div><h3>Objective</h3><div>To investigate the predictive value of HIF-1α for LVR after STEMI based on the echocardiographic parameters.</div></div><div><h3>Methods</h3><div>In this prospective observational study, plasma samples were collected within 12 hours of onset from 183 patients with a first reperfused anterior ST-segment elevation myocardial infarction (STEMI), and HIF-1α levels were measured using enzyme-linked immunosorbent assay (ELISA). At baseline and 12 months after discharge, all patients underwent repeat echocardiography. The changes of echocardiography parameters from baseline to 12 months were used to reflect the changes of ventricular structure and function. An increase in end-diastolic volume of ≥20 % was defined as LVR.</div></div><div><h3>Results</h3><div>The levels of HIF-1α were highly correlated with the changes of echocardiography parameters (ΔLVEF, ΔLVEDD, as well as ΔLVEDV). During the follow-up period, patients with higher HIF-1α concentrations had higher incidence of LVR, poorer ventricular function, and a lower MACE-free survival. Multivariate analysis showed the single-point HIF-1α was an independent predictor of LVR (odds ratio[OR]: 4.813; 95 % CI: 1.553 to 14.918; P = 0.006). The HIF-1α levels predicted LVR with an AUC of 0.7905 (95 % CI: 0.7067 to 0.8744; P &lt; 0.0001). The combination of HIF-1α and N-terminal probrain natriuretic peptide (NT-proBNP) yielded a favorable increase in AUC to 0.8121 (95 % CI: 0.7345 to 0.8896; P &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>These results demonstrate that serum HIF-1α levels can predict LVR after STEMI independently.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 479-484"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreaticopleural fistula","authors":"Abhinav K. Rao MD ,&nbsp;Levi Diggins DO ,&nbsp;Brett Van-Leer Greenberg MD ,&nbsp;James Ravenel MD ,&nbsp;Don C. Rockey MD","doi":"10.1016/j.amjms.2024.11.014","DOIUrl":"10.1016/j.amjms.2024.11.014","url":null,"abstract":"<div><div>A pancreatic fistula is defined as the leakage of pancreatic fluid into another organ or compartment because of pancreatic duct disruption or pseudocyst formation. It is most often seen in middle-aged men between 40 and 50, particularly in patients who have a history of chronic alcoholism and pancreatitis. The tract may fistulae into the pleura, creating a pancreaticopleural fistula, an exceedingly rare condition presenting as a recurrent pleural effusion and extremely high amylase levels, a key distinguishing factor in diagnosis. Here, we present such a case of a recurrent pancreaticopleural fistula and review the presentation, pathophysiology, diagnosis and treatment.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 508-512"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasculitis in patients treated with direct oral anticoagulants","authors":"Giuseppe Famularo MD PhD,&nbsp;Chiara Dell'Unto MD","doi":"10.1016/j.amjms.2024.11.013","DOIUrl":"10.1016/j.amjms.2024.11.013","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 541-543"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular diseases-related mortality among adults with comorbid chronic obstructive pulmonary disease in the United States","authors":"Usama Qamar MD ,&nbsp;Shrihari Nagarajan ,&nbsp;Siddharth Agarwal MD","doi":"10.1016/j.amjms.2024.11.002","DOIUrl":"10.1016/j.amjms.2024.11.002","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 537-540"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research in academic medicine – Just another rich getting richer story?","authors":"Don C. Rockey MD","doi":"10.1016/j.amjms.2025.01.008","DOIUrl":"10.1016/j.amjms.2025.01.008","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 421-422"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carcinoma erysipeloides, a case-report and review of the sixty-nine cases in the literature","authors":"İmdat Eroğlu M.D.,&nbsp;Aytuğ Üner M.D.,&nbsp;Fatih Gürler M.D.,&nbsp;Ozan Yazıcı M.D.,&nbsp;Ahmet Özet M.D.,&nbsp;Nuriye Özdemir M.D.","doi":"10.1016/j.amjms.2024.10.008","DOIUrl":"10.1016/j.amjms.2024.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Carcinoma erysipeloides (CE) is a rare form of cutaneous metastasis appearing similar to erysipelas or cellulitis. Due to its rarity, little is known about CE.</div></div><div><h3>Methods</h3><div>We here initially reported a case of CE secondary to rectal carcinoma and then reviewed the literature and analyzed the basic characteristics of the cases reported previously.</div></div><div><h3>Results</h3><div>Sixty-nine patients(including our case) with CE were identified. The mean age of diagnosis with CE was 60 ± 15 yr(min:25 yr, max:91 yr), and 69.6 % of the patients were female. Breast cancer, skin cancer, and gastroesophageal cancer were the three most commonly seen malignancies presented with CE(52.2 %, 11.6 %, and 10.1 %, respectively). Adenocarcinoma(81.2 %) was the primary histological subtype of the cases. While CE was the first presentation of the disease in 20.3 % of patients, it was associated with recurrence or disease progression in 69.7 %. The median time from the first presentation of the disease to the diagnosis of CE was two years. More than half of the patients(55.1 %) have received local dermatological treatment with another differential diagnosis before diagnosis of CE. Only 21.7 % of the patients responded to the treatment, and median survival after diagnosis of CE was 4 months(min:0 mo, max:24 mo).</div></div><div><h3>Conclusions</h3><div>CE has a poor prognosis and is most common in individuals with breast cancer and adenocarcinoma. Patients generally receive local dermatological treatments with different diagnoses. CE should be considered in the differential diagnosis, especially in the presence of erysipelas/cellulitis-like lesions in patients with a history of malignancy or who do not respond to local treatments.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 485-490"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel predictor for metabolic syndrome: Para-aortic adipose tissue","authors":"Fahri Çakan MD ,&nbsp;Adem Adar MD ,&nbsp;Sinan Akıncı MD ,&nbsp;Uğur Köktürk MD ,&nbsp;Ertan Akbay MD ,&nbsp;Orhan Önalan MD","doi":"10.1016/j.amjms.2024.11.008","DOIUrl":"10.1016/j.amjms.2024.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic Syndrome (MetS) is an independent risk factor for cardiovascular disease. Perivascular fat depots not only serve as energy storage but also function as endocrine organs. Para-aortic adipose tissue (PAT), a perivascular local adipose tissue, has been suggested to play a role in obesity-mediated vascular disease, and has been associated with MetS components and measures of coronary and abdominal aortic calcification. PAT was previously described and examined using tomography and magnetic resonance imaging. This study aimed to describe the features of para-aortic adipose tissue measured echocardiographically in individuals with MetS.</div></div><div><h3>Methods</h3><div>Patients were divided into two groups according to their MetS status. The hypoechoic space in front of the ascending aorta was considered a PAT on the parasternal long-axis view. Possible covariates for the regression analysis were determined using the DAGitty diagram.</div></div><div><h3>Results</h3><div>A total of 494 patients were enrolled in this study. The PAT was significantly higher in the MetS group [9.6 (6.1/10.6) vs. 6.1 (0.9/9) mm, <em>p</em> &lt; 0.001]. Logistic regression analysis revealed that PAT (OR=2,15, <em>p</em> = 0,003) was significantly associated with MetS. 7.55 mm of PAT has a sensitivity of 65 % and specificity of 65 % [AUC = 0.675, <em>p</em> &lt; 0.001, 95 % CI (0.623–0.726)] in predicting the presence of MetS.</div></div><div><h3>Conclusions</h3><div>Based on the measurements obtained using this newly described modality in transthoracic echocardiography, its relationship with MetS was determined. These results can guide clinicians in diagnosing MetS.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 472-478"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between county-level social determinants of health and cardio-kidney-metabolic disease attributed all-cause mortality in the US: A cross sectional analysis","authors":"Antoinette Cotton BS,MBA ,&nbsp;Pedro RVO Salerno MD ,&nbsp;Salil V Deo MD ,&nbsp;Salim S. Virani MD ,&nbsp;Khurram Nasir MD ,&nbsp;Ian Neeland MD ,&nbsp;Sanjay Rajagopalan MD ,&nbsp;Naveed Sattar MD ,&nbsp;Sadeer Al-Kindi MD ,&nbsp;Yakov E Elgudin MD,PhD","doi":"10.1016/j.amjms.2025.01.007","DOIUrl":"10.1016/j.amjms.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>The American Heart Association recently defined cardio-kidney-metabolic (CKM) syndrome as the intersection between metabolic, renal, and cardiovascular disease. Understanding the contemporary estimates of CKM related mortality in the US is essential for developing targeted public interventions.</div></div><div><h3>Methods</h3><div>We analyzed state-level and county-level CKM-associated all-cause mortality data (2010-2019) from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER). Median and interquartile (IQR) age-adjusted mortality rates (aaMR) per 100,000 were reported and linked with a multi-component metric for social deprivation: the Social Deprivation Index (SDI: range 0 - 100) grouped as: I: 0 – 25, II: 26 – 50, III: 51 – 75, and IV: 75 – 100. We fit pairwise comparisons between SDI groups and evaluated aaMR stratified by sex, race, and location.</div></div><div><h3>Results</h3><div>In 3101 counties, pooled aaMR was 505 (441-579). Oklahoma (643) and Massachusetts (364) had the highest and lowest values. aaMR increased across SDI groups [I: 454(404, 505), IV: 572(IQR: 495.9, 654.7); p &lt; 0.001]. Men had higher rates [602 (526, 687)] than women [427 (368, 491)]. Metropolitan [476 (419, 542)] had lower rates than non-metropolitan counties [521 (454, 596)]. Non-Hispanic Black [637 (545, 731)] had higher rates than non-Hispanic White residents [497 (437, 570]. CKM associated aaMR remained reasonably constant between 2010 and 2019 (Mann Kendall test for trend p-value = 0.99).</div></div><div><h3>Conclusions</h3><div>In the US, CKM mortality disproportionately affects more socially deprived counties. Inability to reduce CKM mortality rates over the study period highlights the need for targeted policy interventions to curb the ongoing high burden.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 491-497"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary dickkopf-3 as a predictor for postoperative acute kidney injury in the intensive care unit","authors":"Yao Sun MD ,&nbsp;Zengli Xiao MD ,&nbsp;Huiying Zhao MD,&nbsp;Youzhong An MD","doi":"10.1016/j.amjms.2024.11.003","DOIUrl":"10.1016/j.amjms.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>As a life-threatening complication in patients undergoing surgery, acute kidney injury (AKI) is strongly associated with a worse prognosis. Urinary dickkopf-related protein 3 (DKK3) has been identified as a biomarker for predicting postoperative AKI in patients undergoing cardiac surgery.</div></div><div><h3>Objective</h3><div>To investigate the predictive value of urinary DKK3 on postoperative AKI and develop a clinical model based on the predictor for predicting the development of AKI within seven days for patients undergoing noncardiac surgery.</div></div><div><h3>Methods</h3><div>All patients who were admitted to the Intensive Care Unit (ICU) after noncardiac surgery from March 2023 to June 2023 were included in this study. The patients’ baseline data on demographic characteristics, lifestyle risk factors, medical history, clinical features, and laboratory tests before surgery were collected at the time of admission. Besides, the blood samples for cystatin C and routine laboratory tests and the urine samples for DKK3 tests were simultaneously collected at the time of admission to the ICU. In addition, the independent predictors of postoperative AKI were identified by univariate, multivariate, and LASSO analyses. Moreover, a nomogram for predicting postoperative AKI was developed based on these independent predictors. Finally, the nomogram was evaluated through calibration and decision curve analyses.</div></div><div><h3>Results</h3><div>A total of 166 patients with a median age of 67 years old were included in this study, including 94 (56.63 %) males. Among these patients, 47 patients (28.3 %) developed postoperative AKI. Additionally, 7 independent risk factors, including preoperative serum creatinine, preoperative eGFR, preoperative serum albumin, preoperative serum potassium ion, cystatin C, uDKK3/uCr, and SOFA score, were selected by univariate and multivariate regression analyses. Eventually, 4 independent risk factors (including preoperative eGFR, cystatin C, uDKK3/uCr, and SOFA score) identified in this study by LASSO analyses were used to establish the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) for the prediction model was 0.868. The calibration curve and decision curve analysis results demonstrated that the nomogram had good prediction performance.</div></div><div><h3>Conclusions</h3><div>Urinary DKK3/creatinine was independently associated with postoperative AKI for patients in the ICU after noncardiac surgery. The nomogram constructed based on uDKK3/uCr, preoperative eGFR, cystatin C, and SOFA score showed a higher accuracy in predicting postoperative AKI.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 434-442"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyspnea, dysfunctional breathing disorders, and the Bayesian brain hypothesis","authors":"Gilbert Berdine MD,&nbsp;Kenneth Nugent MD","doi":"10.1016/j.amjms.2024.11.006","DOIUrl":"10.1016/j.amjms.2024.11.006","url":null,"abstract":"<div><div>Clinicians frequently evaluate patients who present with dyspnea. This term describes uncomfortable breathing during physical activity, and the intensity or degree of dyspnea can vary in an individual depending on circumstances and between individuals. In some cases, the level of dyspnea appears out of proportion to other information relevant to the cardiorespiratory system, and this situation has been described as dysfunctional breathing. The Bayesian brain hypothesis helps clinicians understand this symptom in these patients. This hypothesis suggests that prior experiences with dyspnea during physical activity or a respiratory disorder provide the background that is used to interpret current symptoms. This review outlines problems associated with the use of the term “dyspnea” and briefly describes how the Bayesian brain hypothesis might help clinicians understand this symptom better.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 4","pages":"Pages 503-507"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}