American Journal of the Medical Sciences最新文献

{"title":"Utility of arterial to end-tidal carbon dioxide gradient as a severity index in critical care","authors":"Kyung Sook Hong PhD ,&nbsp;Jae Gil Lee PhD ,&nbsp;Tae Yoon Kim MD ,&nbsp;Jae-myeong Lee PhD ,&nbsp;Hoonsung Park MD ,&nbsp;Hanyoung Lee MD ,&nbsp;Na Rae Yang PhD ,&nbsp;Seung Min Baik MD","doi":"10.1016/j.amjms.2024.10.007","DOIUrl":"10.1016/j.amjms.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>The arterial to end-tidal carbon dioxide gradient (P [a-Et] CO₂) reveals the ventilation-perfusion (V/Q) status of critically ill patients. V/Q mismatch has several causes and affects the clinical outcomes of critically ill patients. We investigated the relationship between P (a-Et) CO₂ and the clinical outcomes in critically ill patients.</div></div><div><h3>Methods</h3><div>Critically ill patients (<em>n</em> = 1,978) on mechanical ventilation and capnography in the intensive care units of two institutions were enrolled and categorized into three groups: P (a-Et) CO₂ ≤10 mmHg (low group), 10 mmHg &lt; P (a-Et) CO₂ ≤ 20 mmHg (medium group), and 20 mmHg &lt; P (a-Et) CO₂ (high group).</div></div><div><h3>Results</h3><div>The Acute Physiology and Chronic Health Evaluation <strong>II</strong> score was 29.5 ± 8.1, 31.3 ± 8.2, and 33.3 ± 8.7 in the low, medium, and high groups, respectively (<em>p &lt;</em> 0.001). Overall mortality rates were 25.5 %, 35.6 %, and 52.8 % in the low, medium, and high groups, respectively (<em>p &lt;</em> 0.001). The odds ratio was 1.456 (95 % confidence interval [CI]: 1.117–1.897, <em>p =</em> 0.002) and 2.320 (95 % CI: 1.635–3.293, <em>p &lt;</em> 0.001) for the medium and high groups, respectively, with the low group as a reference. The area under the receiver operating characteristic curve of P (a-Et) CO₂ for overall mortality was 0.604 (<em>p &lt;</em> 0.001).</div></div><div><h3>Conclusions</h3><div>P (a-Et) CO₂ is a simple, easily accessible indicator that potentially impacts patient care and outcomes as an independent marker for assessing disease severity and predicting mortality, especially in non-respiratory critical care scenarios.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 326-333"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559916","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":"Alpha-Gal Syndrome: A Review for the General Internist","authors":"Christopher J Peterson MD, MS ,&nbsp;Poornachandran Mohankumar MD ,&nbsp;James A. Tarbox MD ,&nbsp;Kenneth Nugent MD","doi":"10.1016/j.amjms.2024.11.015","DOIUrl":"10.1016/j.amjms.2024.11.015","url":null,"abstract":"<div><div>Alpha-gal syndrome develops in some individuals who have had tick bites which result in IgE responses to alpha-gal, a carbohydrate not found in humans. Patients with alpha-gal syndrome develop symptoms when they ingest mammalian meat, which contains this oligosaccharide. Often the response to this exposure is delayed and occurs 2 to 6 h post-ingestion. Symptoms can include skin rashes, urticaria, gastrointestinal symptoms, and occasionally anaphylaxis. In some patients, the initial site of the skin reaction is at the location of the prior tick bite. The frequency of the syndrome is uncertain but the geographic distribution is predominantly in areas with the lone star tick. The diagnosis depends on careful attention to the time interval between the ingestion of meat and the development of the symptoms. In addition, a history of prior tick bites is important for considering this diagnosis. Diagnostic studies include skin tests, serologic tests for specific IgE, and food challenges, with varying risks for anaphylaxis. The treatment of patients with acute presentations frequently includes intramuscular epinephrine, oral antihistamines, and corticosteroids. Long-term management involves diet modification with the elimination of meat. Patients can also have adverse reactions to medications, such as set cetuximab, heparin, monoclonal antibodies, and pancreatic enzymes, and clinicians will likely have difficulty identifying these reactions. If patients have a good response to diet modification and have a significant reduction in their specific IgE level to alpha-gal, they potentially can resume eating meat in their diet. This should be done under the direction of a specialist.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 313-320"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775998","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":"Challenges in multimodal chronic pain management in primary care settings","authors":"Olivia Tincher DO ,&nbsp;Mahmoud Abdelnabi MD, MSc ,&nbsp;Neha Mittal MD, FACP","doi":"10.1016/j.amjms.2024.10.004","DOIUrl":"10.1016/j.amjms.2024.10.004","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 305-306"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559914","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":"Pleural complications in patients with renal cell carcinoma undergoing percutaneous cryoablation: A retrospective analysis of its incidence and risk factors","authors":"Ibrahim Khatim MBBS ,&nbsp;Isam Albaba MBBS ,&nbsp;Marc A Judson MD ,&nbsp;Kurt Hu MD ,&nbsp;Sana Ali MBBS ,&nbsp;Harpreet Singh MBBS ,&nbsp;Khezar Syed MD ,&nbsp;Moses Koo MD ,&nbsp;Timothy Yung MD ,&nbsp;Paul Feustel phD ,&nbsp;Ramkrishna Patel MD ,&nbsp;Gary Siskin MD ,&nbsp;Amit Chopra MD","doi":"10.1016/j.amjms.2024.09.003","DOIUrl":"10.1016/j.amjms.2024.09.003","url":null,"abstract":"<div><h3>Rationale</h3><div>Observations from our clinical practice indicate a notable occurrence of pleural complications post-percutaneous renal cryoablation (PRC).</div></div><div><h3>Objective</h3><div>To identify the incidence of pleural complications following PRC and potential risk factors associated with post-procedural pleural complications.</div></div><div><h3>Materials and Methods</h3><div>This was a retrospective cohort analysis of patients undergoing PRC at two tertiary hospital systems between 2016 and 2022. Patient characteristics, radiological and clinical data, and procedure techniques were collected in a database to identify potential risk factors.</div></div><div><h3>Results</h3><div>A total of 285 patients were identified who underwent 312 PRC procedures during the specified inclusion period. Among these, 10 procedures (3.2 %) led to pleural complications, all manifesting as pleural effusions. Of these complications, 3 patients (1 %) required pleural drainage. Factors associated with an increased risk of pleural complications included a larger mean tumor size (4.3 cm vs 2.7 cm, <em>P</em> = &lt;0.001), cryoprobe applicator entry at the T10-T11 level as opposed to lower sites (<em>P</em> = 0.029), and a higher median number of cryoprobe applicators employed (3.5 vs 2.0, <em>P</em> = 0.001). Moreover, individuals who experienced pleural complications had a longer median hospital stay (4.0 vs 0, <em>P</em> ≤ 0.001) and a higher rate of blood transfusions (40 % vs 0.7 %, <em>P</em> ≤ 0.001).</div></div><div><h3>Conclusion</h3><div>Pleural complications from percutaneous renal cryoablation are rare. To further reduce the risk, higher insertion points (above T12) and utilizing more than two cryoprobe applicators should be avoided when feasible. Pleural complications in patients with new respiratory symptoms after PRC should be considered.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 334-338"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305282","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":"Neurosarcoidosis complicated by systemic vasculitis","authors":"Alexander Carvajal-González MD, PhD ,&nbsp;Octavio Arevalo-Espejo MD ,&nbsp;Maria Carolina Beeter MD ,&nbsp;Sarwat Umer MD ,&nbsp;Oleg Chernyshev MD, PhD","doi":"10.1016/j.amjms.2024.09.008","DOIUrl":"10.1016/j.amjms.2024.09.008","url":null,"abstract":"<div><div>A 62-year-old woman with medical history of hypertension, diabetes mellitus, coronaropathy, neurosarcoidosis, s/p craniotomy (brain mass resection) presented with worsening headaches, generalized weakness, vomiting, and hyporexia over two weeks. Brain MRI showed worsening of the known right cavernous sinus mass, vasculitis panel was negative. Patient received IV steroids; during hospitalization, she had a syncopal episode, CT Head was normal, EKG showed new T-wave inversion with troponin elevation. She experienced worsening mentation, left-sided hemiparesis; CT head showed acute hypodensity in the right MCA territory, CTA revealed bilateral distal M1 segment stenosis. Ineligible for thrombolysis/thrombectomy, she was started on aspirin. Echocardiograms were normal. Ischemic signs in her right toes prompted an aortogram showing arterial obstructions in the RLE, necessitating SFA stent placement, and clopidogrel. IV cyclophosphamide was added without additional vascular complications. This case illustrates neurosarcoidosis complicated by systemic vasculitis of medium-large vessels, responding to aggressive immunosuppression with glucocorticoids and cytotoxic agents.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 385-389"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335555","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":"UBE2Q1 as a novel cancer biomarker for lung adenocarcinoma","authors":"Wei Jiang MD ,&nbsp;Yuchao Wang MD ,&nbsp;Jue Zou MD ,&nbsp;Li Li MD ,&nbsp;Chunhua Xu MD","doi":"10.1016/j.amjms.2024.10.002","DOIUrl":"10.1016/j.amjms.2024.10.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Ubiquitin-conjugating enzymes (E2s) participate in various tumor-promoting processes. UBE2Q1 is a member of the E2 family. This research aimed to detect the expression level of UBE2Q1 in human lung adenocarcinoma and to study its malignant biological function.</div></div><div><h3>Methods</h3><div>Western blot, qRT-PCR and immunohistochemistry was used to measure the expression of UBE2Q1 in human lung adenocarcinoma tissues. The association between UBE2Q1 expression and clinic-pathological variables in 99 lung adenocarcinoma samples was analyzed by immunohistochemistry. In vitro experiment, establishing UBE2Q1 knockdown pattern, the markers of apoptosis, cell cycle and epithelial-mesenchymal transition (EMT) were analyzed by Western blot. CCK8, colony formation, Transwell and invasion assay analyzed the effect of UBE2Q1 knockdown on the proliferation, metastasis and invasion of lung cancer cells.</div></div><div><h3>Results</h3><div>UBE2Q1 was overexpressed in lung adenocarcinoma, and the expression level of UBE2Q1 was related with TNM stage, tumor size, and lymph node metastasis. The high level of UBE2Q1 expression was also associated with poor survival and was an independent risk factor. In vitro, It was also confirmed that steady downregulation of UBE2Q1 could promote apoptosis, induce G2/M cell cycle arrest and regulate EMT. UBE2Q1 silencing dramatically reduce lung tumor cells proliferation, migration and invasion capacities.</div></div><div><h3>Conclusions</h3><div>UBE2Q1 may serve as a prognostic biomarker and a new therapeutic target of lung adenocarcinoma.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 359-365"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402543","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":"Racial disparities exist in utilization of catheter ablation for atrial fibrillation in the United States","authors":"Muhammad Ali Tariq M.B.B.S. ,&nbsp;Minhail Khalid Malik M.B.B.S. ,&nbsp;Aeman Asrar M.D.","doi":"10.1016/j.amjms.2024.10.010","DOIUrl":"10.1016/j.amjms.2024.10.010","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 415-418"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559915","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":"Lung transplant access disparities for Asian patients with idiopathic pulmonary fibrosis","authors":"Aaron Pathak ,&nbsp;Shreyas Sinha ,&nbsp;Neeraj Sinha M.D.","doi":"10.1016/j.amjms.2024.09.006","DOIUrl":"10.1016/j.amjms.2024.09.006","url":null,"abstract":"","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 413-414"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305281","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":"An observational study of the causes of an isolated elevated alkaline phosphatase level of unclear etiology","authors":"William Jones M.D.,&nbsp;Don C. Rockey M.D.","doi":"10.1016/j.amjms.2024.10.003","DOIUrl":"10.1016/j.amjms.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Serum alkaline phosphatase (ALP) is a commonly obtained laboratory test, but its diagnostic specificity is limited because it is found in multiple tissues. We investigated patients with isolated, elevated, ALP levels without an obvious etiology at presentation to determine the frequency of different causes of an isolated elevated ALP.</div></div><div><h3>Methods</h3><div>This was a retrospective, cohort study of adults (age &gt;18 years old) from January 1st, 2013, to June 30th, 2020 in both the in- and outpatient setting at the Medical University of South Carolina. 260 patients with an isolated, elevated ALP of unknown etiology (patients with known biliary obstruction, underlying parenchymal liver disease, or pregnancy were excluded) were included. A secondary outcome was mean survival time from the ALP result.</div></div><div><h3>Results</h3><div>The most common cause of ALP elevation was due to underlying malignancy (147, 57 %), with 61 patients having infiltrative intrahepatic malignancy, 52 patients having bony metastasis, and 34 patients having both hepatic and bone metastasis. Bone disease (75, 29 %), unsuspected parenchymal liver disease (18, 7 %), non-malignant infiltrative liver disease (7, 2 %), and other disorders (13, 5 %) accounted for the remainder of the cohort. Notably, 123 of 260 (47 %) patients died within an average of 58 months after identification of isolated, elevated ALP.</div></div><div><h3>Conclusions</h3><div>An isolated, elevated ALP of unclear etiology is associated with several very specific and important disorders, in particular metastatic intrahepatic malignancy - and is uncommonly associated with primary parenchymal liver disease. Providers should be aware of the potential clinical significance of an elevated ALP.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 354-358"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515660","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":"Effect of therapeutic lifestyle changes on patients with overweight/obesity and non-alcoholic fatty liver disease: A randomized controlled trial","authors":"Xishun Huang Ph.D. ,&nbsp;Meixuan Luo Ph.D. ,&nbsp;YanYan Zeng Ph.D. ,&nbsp;Jiao Yi Ph.D. ,&nbsp;Sumei Lin Ph.D. ,&nbsp;Yitao Wang Ph.D. ,&nbsp;Xuan Zheng Ph.D. ,&nbsp;Xiaohua Luo Ph.D.","doi":"10.1016/j.amjms.2024.10.005","DOIUrl":"10.1016/j.amjms.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Non-alcoholic fatty liver disease is a liver condition that is increasing globally. Unfortunately, there are no successful or approved pharmacological treatments for non-alcoholic fatty liver disease. Hence, this study aimed to investigate the effect of therapeutic lifestyle changes on patients with overweight/obesity and non-alcoholic fatty liver disease.</div></div><div><h3>Methods</h3><div>A prospective, parallel-group, randomized controlled trial was conducted. The patients were randomized into intervention and control groups using tables with random numbers. In the control group, routine health guidance was provided for 3 months, while in the intervention group, diversified lifestyle intervention was provided. The body composition, visceral fat area, abdominal circumference, and body mass index of the control and intervention groups were compared before and after the intervention. Descriptive statistics, paired <em>t</em>-tests, and linear regression models were used for data analysis.</div></div><div><h3>Results</h3><div>A total of 115 participants (57 in the intervention group and 58 in the control group) completed the study. The intervention groups had significantly greater high-density lipoprotein cholesterol levels, basal metabolic rate, muscle mass, and questionnaire scores than the control groups (<em>P</em> &lt; 0.05). Furthermore, the intervention participants had lower body mass index, abdominal circumference, triglyceride levels, low-density lipoprotein cholesterol levels, and fatty liver index (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Therapeutic lifestyle changes therapy for non-alcoholic fatty liver disease patients with overweight/obesity can significantly control body mass index, improve blood lipid levels, reduce fatty liver and body fat rates, improve basic metabolism, alleviate disease, and improve quality of life. More research is needed to determine the long-term impact of therapeutic lifestyle changes in high-risk groups.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"369 3","pages":"Pages 373-379"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515663","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}