The 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, Jae Gil Lee, Tae Yoon Kim, Jae-Myeong Lee, Hoonsung Park, Hanyoung Lee, Na Rae Yang, Seung Min Baik","doi":"10.1016/j.amjms.2024.10.007","DOIUrl":"10.1016/j.amjms.2024.10.007","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>Critically ill patients (n = 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 < P (a-Et) CO₂ ≤ 20 mmHg (medium group), and 20 mmHg < P (a-Et) CO₂ (high group).</p><p><strong>Results: </strong>The Acute Physiology and Chronic Health Evaluation II score was 29.5 ± 8.1, 31.3 ± 8.2, and 33.3 ± 8.7 in the low, medium, and high groups, respectively (p < 0.001). Overall mortality rates were 25.5 %, 35.6 %, and 52.8 % in the low, medium, and high groups, respectively (p < 0.001). The odds ratio was 1.456 (95 % confidence interval [CI]: 1.117-1.897, p = 0.002) and 2.320 (95 % CI: 1.635-3.293, p < 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 (p < 0.001).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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, Mahmoud Abdelnabi, Neha Mittal","doi":"10.1016/j.amjms.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.amjms.2024.10.004","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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, Minhail Khalid Malik, Aeman Asrar","doi":"10.1016/j.amjms.2024.10.010","DOIUrl":"10.1016/j.amjms.2024.10.010","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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, Aytuğ Uner, Fatih Gurler, Ozan Yazıcı, Ahmet Ozet, Nuriye Ozdemir","doi":"10.1016/j.amjms.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.amjms.2024.10.008","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary embolism and acute limb ischemia without pre-existing atrial fibrillation: Hunt for the hidden thrombus.","authors":"Misha Aftab Khan, Noor Alsammarraie, Alycia Christina Bellino, Yash Bharatkumar Patel, Karldon Iwuchukwu Nwaezeapu","doi":"10.1016/j.amjms.2024.10.006","DOIUrl":"10.1016/j.amjms.2024.10.006","url":null,"abstract":"<p><p>Coronary embolism (CE) is an infrequent etiology of myocardial infarction secondary to embolization of occlusive thrombi within the coronary arteries, typically arising in patients with pre-existing atrial fibrillation. Clinical presentation is similar to atherosclerotic myocardial infarction, however the condition is likely underrecognized. The simultaneous presence of other embolic manifestations may assist with diagnosis, although definitive therapy, medical or interventional, remains inconclusive. We aim to lower the threshold for clinical suspicion in the appropriate setting and promote assessment of predisposing embolic conditions once a tentative diagnosis of CE is established. In addition, we intend to highlight the need for focused refinement of the existing diagnostic criteria and further optimization of management guidelines for CE.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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, Don C Rockey","doi":"10.1016/j.amjms.2024.10.003","DOIUrl":"10.1016/j.amjms.2024.10.003","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>This was a retrospective, cohort study of adults (age >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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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, Meixuan Luo, YanYan Zeng, Jiao Yi, Sumei Lin, Yitao Wang, Xuan Zheng, Xiaohua Luo","doi":"10.1016/j.amjms.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.amjms.2024.10.005","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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 t-tests, and linear regression models were used for data analysis.</p><p><strong>Results: </strong>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 (P < 0.05). Furthermore, the intervention participants had lower body mass index, abdominal circumference, triglyceride levels, low-density lipoprotein cholesterol levels, and fatty liver index (P < 0.05).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutropenia and SARS-CoV-2 infection, A review of the literature.","authors":"Behnaz Esmaeili, Shahnaz Esmaeili","doi":"10.1016/j.amjms.2024.10.001","DOIUrl":"10.1016/j.amjms.2024.10.001","url":null,"abstract":"<p><p>According to reports, coronavirus disease 2019 (COVID-19) is associated with various complications, including hematological abnormalities. Lymphopenia and thrombocytopenia have been recognized as common hematological abnormalities. Moreover, some reports have shown cases of neutropenia occurring during or after infection with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Neutropenia is a condition characterized by a decrease in the absolute neutrophil count (ANC) to less than 1500/µ. Although neutropenia has been considered a rare complication of SARS-Cov-2 infection, it is important to closely monitor patients and thoroughly investigate all laboratory findings, particularly in those with severe COVID-19. This will allow for effective therapeutic intervention and appropriate disease management in challenging conditions. In this study, our aim was to conduct a comprehensive review of the current literature on neutropenia during or after SARS-CoV2 infection. Furthermore, we assessed whether there have been any documented cases of immune-mediated neutropenia following COVID-19 and if the appropriate laboratory investigations have been carried out in these patients.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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: Short Title: Oncogenic function of UBE2Q1 in lung adenocarcinoma.","authors":"Wei Jiang, Yuchao Wang, Jue Zou, Li Li, Chunhua Xu","doi":"10.1016/j.amjms.2024.10.002","DOIUrl":"10.1016/j.amjms.2024.10.002","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>UBE2Q1 may serve as a prognostic biomarker and a new therapeutic target of lung adenocarcinoma.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The expression and clinical significance of cytokines Th1, Th2, and Th17 in ovarian cancer.","authors":"Chibo Liu, Dongguo Wang, Xingtang Huang, Zhiwei Song, Liuqing Ye, Guoming Zhou","doi":"10.1016/j.amjms.2024.08.029","DOIUrl":"10.1016/j.amjms.2024.08.029","url":null,"abstract":"<p><strong>Background: </strong>This study was to analyze the levels of Th1, Th2 and Th17 cytokines in peripheral blood samples from ovarian cancer (OC) patients.</p><p><strong>Methods: </strong>Ninty-five OC patients including 45 OC and 50 benign ovarian disease (BOD) were selected at Zhejiang Cancer Hospital from October 2021 to March 2022; 46 healthy participants were simultaneously selected at Taizhou Municipal Hospital as healthy controls (HC). The expressions of Th1, Th2 and Th17 were compared in all participants. Marker levels were analyzed with age, histological type, tumor size, ovarian number and clinical stage of OC.</p><p><strong>Results: </strong>The IL6 and IL8 levels were significantly higher in OC compared to BOD and HC (p < 0.00). The IL-4 expression was significantly higher in OC compared to HC (p < 0.00). The expressions of IL2, IL6 and IL10 were significantly higher in pathological stage III-IV OC compared with pathological stage I-II OC (p < 0.05). Meanwhile, the levels of IL-2 and IL-10 were significantly higher in OC with bilateral ovaries than in OC with single ovary (p < 0.05). AUCs of different markers were to diagnose OC. The findings also implied that the expressions of IL-6, IL-8 and IL-10 were significantly different between OC and control groups (p < 0.05), while the levels of IL-2, IL-4, TNF-α, IFN-γ, IL-12p70, IL-1β and IL-5 between the two groups were not different (p > 0.05).</p><p><strong>Conclusions: </strong>In peripheral blood from OC patients, the immune system was more dysregulated and immune cells produced more cytokines with contrasting actions. These data showed significant clinical implications for the diagnosis of OC.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}