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Effect of genetic liability to migraines on spontaneous coronary artery dissection and fibromuscular dysplasia. 偏头痛遗传易感性对自发性冠状动脉剥离和纤维肌肉发育不良的影响。
The American journal of the medical sciences Pub Date : 2025-06-16 DOI: 10.1016/j.amjms.2025.06.007
Yun-Hu Chen, Fang Yan
{"title":"Effect of genetic liability to migraines on spontaneous coronary artery dissection and fibromuscular dysplasia.","authors":"Yun-Hu Chen, Fang Yan","doi":"10.1016/j.amjms.2025.06.007","DOIUrl":"10.1016/j.amjms.2025.06.007","url":null,"abstract":"<p><strong>Background: </strong>Associations among migraines, spontaneous coronary artery dissection (SCAD), and fibromuscular dysplasia (FMD) have been reported; however, their causality is inconclusive.</p><p><strong>Methods: </strong>We inferred a causal relation between exposure (migraines) and outcomes (SCAD and FMD) using two-sample MR analysis. Mediation analysis was performed using reverse and multivariate MR analysis methods. Finally, using two-sample MR analysis, we explored whether the currently perceived potential risk factors for SCAD and FMD mediate the aforementioned causal association.</p><p><strong>Results: </strong>Inverse Variance Weighted (IVW) analysis showed that migraines increased the risk of developing SCAD and FMD. SCAD increases the risk of developing FMD. Reverse causality or pleiotropy was not observed. Multivariate random IVW analysis showed that the effect of migraine on FMD was no longer significant in the multivariate model, whereas the effect of SCAD remained significant. SCAD mediated the causal association between migraine and FMD, with a mediating effect of 0.119 and a proportion of 18.30 %. IVW analyses did not find direct evidence that these associations were consistently related to other potential pathogenic factors of SCAD or FMD.</p><p><strong>Conclusions: </strong>Migraines are a risk factor for both SCAD and FMD, whereas SCAD is an incomplete mediator of the causal relation between migraine and FMD. However, mechanistic studies are warranted to investigate this link.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295561","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}
引用次数: 0
Therapeutic efficacy of scopoletin on oxidative stress and cardiac dysfunction in streptozotocin-induced diabetic rats. 东莨菪碱对链脲佐菌素诱导的糖尿病大鼠氧化应激和心功能障碍的治疗作用。
The American journal of the medical sciences Pub Date : 2025-06-13 DOI: 10.1016/j.amjms.2025.06.010
Abdelrahim Alqudah, Esam Qnais, Omar Gammoh, Yousra Bseiso, Mohammed Wedyan, Sireen Abdul Rahim Shilbayeh, Rawan Abudalo, Muna Oqal, Alaa A A Aljabali
{"title":"Therapeutic efficacy of scopoletin on oxidative stress and cardiac dysfunction in streptozotocin-induced diabetic rats.","authors":"Abdelrahim Alqudah, Esam Qnais, Omar Gammoh, Yousra Bseiso, Mohammed Wedyan, Sireen Abdul Rahim Shilbayeh, Rawan Abudalo, Muna Oqal, Alaa A A Aljabali","doi":"10.1016/j.amjms.2025.06.010","DOIUrl":"10.1016/j.amjms.2025.06.010","url":null,"abstract":"<p><strong>Background: </strong>Cardiac dysfunction associated with diabetes often arises as a serious condition, primarily driven by persistent oxidative imbalance and chronic inflammation. There are few treatments for such complication and therefore, there is considerable interest in natural compounds such as scopoletin has antioxidative and anti-inflammatory activities. This study investigates how scopoletin may influence disease progression in a rat model of diabetic cardiomyopathy induced by streptozotocin (STZ).</p><p><strong>Methods: </strong>Thirty-two male Wistar rats were evenly distributed into four study groups using a randomization protocol: a non-diabetic control, an untreated diabetic group, a diabetic group administered scopoletin, and a diabetic group treated with metformin (Glucophage) as a reference therapy. Post-diabetes induction by streptozotocin, treatments were administered for three weeks, subsequently, malondialdehyde (MDA) concentrations were measured along with, the enzymatic activities of key cardiac antioxidants-superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx)-were evaluated to assess oxidative defense status. ATPase activities, gene expression (p53 and VCAM-1), and histopathological examinations of heart tissues.</p><p><strong>Results: </strong>Scopoletin treatment significantly reduced MDA levels by up to 35 %, with p < 0.01 compared to the diabetic control. Antioxidant enzyme activities were notably enhanced, with increases in SOD, CAT, and GPx activities by approximately 50 % (p < 0.01). Cardiac ATPase activities showed marked improvement (p < 0.05), and the expression of p53 and VCAM-1 was effectively downregulated (p < 0.01). Histopathological analysis revealed substantial reductions in myocardial damage, vacuolation, and tissue congestion in scopoletin-treated groups, with the high-dose effects comparable to those observed with metformin (Glucophage).</p><p><strong>Conclusions: </strong>Scopoletin demonstrates significant potential in treating diabetic cardiomyopathy. These results encourage further clinical trials to explore scopoletin as a complementary therapy for cardiac complications in diabetic patients.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304200","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}
引用次数: 0
Impact of inhaler treatments on respiratory functions and exacerbation frequency in non-cystic fibrosis bronchiectasis. 吸入器治疗对非囊性纤维化支气管扩张呼吸功能和加重频率的影响。
The American journal of the medical sciences Pub Date : 2025-06-13 DOI: 10.1016/j.amjms.2025.06.008
Uğur Fidan, Deniz Kızılırmak, Ayşın Şakar Coşkun
{"title":"Impact of inhaler treatments on respiratory functions and exacerbation frequency in non-cystic fibrosis bronchiectasis.","authors":"Uğur Fidan, Deniz Kızılırmak, Ayşın Şakar Coşkun","doi":"10.1016/j.amjms.2025.06.008","DOIUrl":"10.1016/j.amjms.2025.06.008","url":null,"abstract":"<p><strong>Background: </strong>Bronchiectasis is a chronic airway disease caused by abnormal and permanent dilation of the airways. This study aimed to evaluate the effects of inhaler therapy use on respiratory functions and clinical outcomes in patients with non-cystic fibrosis bronchiectasis.</p><p><strong>Methods: </strong>One hundred forty-six patients with non-cystic fibrosis bronchiectasis aged over 18 years, diagnosed using high-resolution computed tomography, were included in the study. Age, sex, body mass index, smoking status, additional diseases, known etiologic factors, and vaccination status of the patients included in the retrospectively designed study were recorded as sociodemographic data. Respiratory functions, disease severity, and clinical outcomes of patients with bronchiectasis who did and did not receive inhaled anticholinergic and steroid treatments were compared.</p><p><strong>Results: </strong>Ninety (61.6 %) of the 146 patients included in the study were women. The mean age was 56.14 ± 16.22 years. The etiology of bronchiectasis was unknown in 78 (53.4 %) patients. The most prevalent comorbidity was asthma. According to modified Reiff scoring, 91 (62.3 %) patients were classified as having mild bronchiectasis. Twenty-six (17.8 %) patients had airway obstruction. There were 93 (63.7 %) patients using inhaled corticosteroids and 32 (21.9 %) using inhaled anticholinergics.</p><p><strong>Conclusions: </strong>It was determined that patients using inhaler anticholinergics or inhaled steroids were in the more severe group. However, inhaler anticholinergic and inhaler steroid treatments had no effect on hospital admissions and exacerbation frequency in patients with bronchiectasis. Hospitalizations were more frequent among patients with bronchiectasis using inhaled steroids.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304199","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}
引用次数: 0
Association of hepatitis B virus infection and helicobacter pylori co-infection with gastric disorders and cancer. 乙型肝炎病毒感染和幽门螺杆菌合并感染与胃疾病和胃癌的关系:一项在中国人群中的研究
The American journal of the medical sciences Pub Date : 2025-06-13 DOI: 10.1016/j.amjms.2025.06.009
Xiaoying Wu, Jianhua Yu, Xi Luo, Yuntong Lan
{"title":"Association of hepatitis B virus infection and helicobacter pylori co-infection with gastric disorders and cancer.","authors":"Xiaoying Wu, Jianhua Yu, Xi Luo, Yuntong Lan","doi":"10.1016/j.amjms.2025.06.009","DOIUrl":"10.1016/j.amjms.2025.06.009","url":null,"abstract":"<p><strong>Background and aims: </strong>The relationship between hepatitis B virus (HBV) and gastric disorders remains elusive. This study aimed to assess the associations between HBV infection and three gastric disorders. To our knowledge, this is among the first studies to report a synergistic association between HBV and HP co-infection and gastric cancer risk.</p><p><strong>Methods: </strong>HBV-positive patients (n = 352) and HBV-negative controls (n = 520) were recruited from June 2018 to May 2020 at the People's Hospital of Qijiang District. All patients were examined with gastroscopy and histopathological analysis was performed on gastric specimens. HBV DNA and hepatitis B virus surface antigen (HBsAg) were detected by qPCR and the enzyme-linked immunosorbent assay (ELISA), respectively. The relationship of HBV infection with gastric disorders was evaluated by logistic regression analysis. Survival and relapse rates of HBV gastric cancer (GC) cases were estimated using the Kaplan-Meier survival curve and Cox proportional hazard regression model.</p><p><strong>Results: </strong>Gastric mucosal lesions were more serious in the HBV-positive group than in the HBV- negative groups (P < 0.05). HBV DNA and HBsAg levels were strongly correlated with the manifestation of gastritis, gastric ulcer, and GC, and were the highest in GC patients. HBV and Helicobacter Pylori (HP) infections were identified as risk factors for GC (P < 0.05). HBV was significantly associated with gastric ulcer (OR = 10.51, 95 % CI = 5.66-19.52, p < 0.01) and gastric cancer (OR = 2.21, 95 % CI = 1.21-3.47, p = 0.037), while co-infection with HP further increased GC risk (OR = 3.39, 95 % CI = 1.71-6.12, p < 0.01).</p><p><strong>Conclusions: </strong>HBV infection was correlated with some gastric lesions. HBV infection alone might be a risk factor of GC. HBV infection potently increases the risk of GC in HP-positive patients.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304198","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}
引用次数: 0
Increased prevalence, ER visits, and hospitalizations in medicare systemic lupus erythematosus patients living in socially vulnerable counties: A cross-sectional study. 生活在社会脆弱县的医保系统性红斑狼疮患者患病率、急诊就诊和住院率增加:一项横断面研究。
The American journal of the medical sciences Pub Date : 2025-06-12 DOI: 10.1016/j.amjms.2025.05.009
Emily R Cosentino, James C Oates Jim
{"title":"Increased prevalence, ER visits, and hospitalizations in medicare systemic lupus erythematosus patients living in socially vulnerable counties: A cross-sectional study.","authors":"Emily R Cosentino, James C Oates Jim","doi":"10.1016/j.amjms.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.05.009","url":null,"abstract":"<p><strong>Background: </strong>Systemic Lupus Erythematosus (SLE) disproportionately affects women, minorities, and individuals with low socioeconomic status. We hypothesized that counties with a higher percentage of disadvantaged individuals have a higher prevalence of SLE and increased acute hospital events, including emergency room (ER) visits and hospitalizations, among Medicare patients with SLE.</p><p><strong>Methods: </strong>This cross-sectional study used the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) and Lupus Research Alliance's Lupus Index Medicare data. SLE was identified through Medicare fee-for-service administrative records from 2016 containing two or more ICD-10 codes for SLE. We examined SLE prevalence, acute hospital events, and their association with county-level SVI rankings.</p><p><strong>Results: </strong>The study population was 89 % female and 69 % White, with 22 % Black. SVI ranking (r = 0.508) and its subthemes correlated with SLE prevalence, with socioeconomic status and household composition showing the strongest associations (R = 0.431 and R = 0.365, respectively). Similar but weaker correlations were seen between SVI and acute healthcare events, including ER visits and hospitalizations. Limitations include the cross-sectional design preventing longitudinal analysis, reliance on administrative data potentially introducing bias, and exclusion of counties with fewer than 10 SLE patients.</p><p><strong>Conclusions: </strong>This is the first study linking county-level vulnerability to SLE prevalence and healthcare events in a Medicare SLE population. Findings suggest that social and environmental factors influence SLE risk and healthcare utilization, much like other chronic diseases. The modest association between location and hospital/ER events suggests that structural factors may act as barriers to optimal care and outcomes.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295562","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}
引用次数: 0
Increased susceptibility to vibrio vulnificus infection in patients with MASLD, cirrhosis, and chronic liver diseases. 肝病、肝硬化和慢性肝病患者对创伤弧菌感染的易感性增加
The American journal of the medical sciences Pub Date : 2025-06-05 DOI: 10.1016/j.amjms.2025.06.002
Mohammad Aldiabat, Yassine Kilani, Mahmoud Y Madi, Punnag Saha, Subhajit Roy, Don C Rockey, Saurabh Chatterjee, Wing-Kin Syn
{"title":"Increased susceptibility to vibrio vulnificus infection in patients with MASLD, cirrhosis, and chronic liver diseases.","authors":"Mohammad Aldiabat, Yassine Kilani, Mahmoud Y Madi, Punnag Saha, Subhajit Roy, Don C Rockey, Saurabh Chatterjee, Wing-Kin Syn","doi":"10.1016/j.amjms.2025.06.002","DOIUrl":"10.1016/j.amjms.2025.06.002","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251619","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}
引用次数: 0
Elevated blood anandamide levels in acute COVID-19 pneumonia with respiratory failure. 急性COVID-19肺炎合并呼吸衰竭患者血anandamide水平升高。
The American journal of the medical sciences Pub Date : 2025-06-04 DOI: 10.1016/j.amjms.2025.06.003
Abhishek Basu, Lenny Pommerolle, Muhammad Arif, Angelo Y Meliton, Inemesit Udofia, David Wu, Gökhan M Mutlu, Bernadette R Gochuico, Ross Summer, Ayodeji Adegunsoye, Ellen L Burnham, Resat Cinar
{"title":"Elevated blood anandamide levels in acute COVID-19 pneumonia with respiratory failure.","authors":"Abhishek Basu, Lenny Pommerolle, Muhammad Arif, Angelo Y Meliton, Inemesit Udofia, David Wu, Gökhan M Mutlu, Bernadette R Gochuico, Ross Summer, Ayodeji Adegunsoye, Ellen L Burnham, Resat Cinar","doi":"10.1016/j.amjms.2025.06.003","DOIUrl":"10.1016/j.amjms.2025.06.003","url":null,"abstract":"<p><strong>Background: </strong>Subsets of COVID-19 pneumonia patients with acute respiratory failure experienced long-term respiratory dysfunction and persistent radiological abnormalities. However, mechanisms contributing to persistent pulmonary dysfunction following COVID-19 remain unclear. Increased cannabinoid receptor 1 (CB<sub>1</sub>R) expression has been reported in the lungs of patients who died from COVID-19 pneumonia. Multiple studies indicate that CB<sub>1</sub>R overactivation exacerbates inflammation and tissue disrepair in mice, and the level of anandamide (AEA), an endogenous CB<sub>1</sub>R agonist and endocannabinoid, is higher in the lungs of patients with pulmonary fibrosis, correlating with poor lung function. These observations suggest the potential for overactivity of the endocannabinoid/CB<sub>1</sub>R pathway to adversely impact lung repair in COVID-19 pneumonia.</p><p><strong>Methods: </strong>In this study, we sought to determine the relationship between circulating endocannabinoids and inflammatory mediators in patients with COVID-19 pneumonia from two independent cohorts in different geographic US locations. Endocannabinoid levels were measured using liquid chromatography coupled triple quadrupole mass spectrometry, while inflammatory cytokines and chemokines were measured using Luminex assay in blood serum collected at various time points during COVID-19 pneumonia.</p><p><strong>Results: </strong>We found that blood serum levels of endocannabinoid AEA were significantly elevated in acute COVID-19 pneumonia patients compared to patients with non-COVID-19-associated acute respiratory failure, and healthy controls. Further, 2-arachidonyl glycerol (2AG)] was significantly elevated in acute COVID-19 pneumonia patients on par with non-COVID acute respiratory failure patients. Levels of circulating AEA and 2AG correlated with multiple inflammatory markers.</p><p><strong>Conclusions: </strong>Our findings suggest increased circulating endocannabinoid tone may be involved in the pathogenesis of COVID-19 pneumonia during the acute phase of illness.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnostic value of novel thrombus markers in COPD with deep venous thrombosis. 新型血栓标志物对慢性阻塞性肺疾病合并深静脉血栓的诊断价值。
The American journal of the medical sciences Pub Date : 2025-06-04 DOI: 10.1016/j.amjms.2025.06.006
Jiajun Huang, Jie Huang, Chunli Sun, Feng Tian, Jufang Wang
{"title":"Diagnostic value of novel thrombus markers in COPD with deep venous thrombosis.","authors":"Jiajun Huang, Jie Huang, Chunli Sun, Feng Tian, Jufang Wang","doi":"10.1016/j.amjms.2025.06.006","DOIUrl":"10.1016/j.amjms.2025.06.006","url":null,"abstract":"<p><strong>Background: </strong>This study assesses the diagnostic value of new thrombosis markers, including thrombin antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC), for the incidence prediction of deep venous thrombosis (DVT) of lower limb in chronic obstructive pulmonary disease (COPD) patients.</p><p><strong>Methods: </strong>98 patients with COPD admitted to Shenzhen Guangming district people's hospital from March 2020 to May 2022 and were selected and divided into a non-DVT group (n = 62) and a DVT (n = 36) group. A control group consisting of 50 healthy subjects were recruited. The blood sugar and lipid metabolic indicators of patients in each group were analyzed and compared. ROC curve analysis was performed to assess the diagnostic efficacy of new thrombosis markers.</p><p><strong>Results: </strong>There were no significant differences in the levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) among the three groups. The DVT group exhibited higher levels of fibrin degradation product (FDP) and D-dimer (D-D) than the non-DVT group. The plasma levels of TAT, PIC, TM, and t-PAIC in the DVT group significantly elevated compared to the other two groups. Combined diagnosis of TAT and TM displayed superior diagnostic efficacy with maximum AUC values (0.833) and a sensitivity of 87.5 %.</p><p><strong>Conclusions: </strong>The detection of serum levels of TAT, PIC, TM, and t-PAIC have diagnostic value in COPD patients with DVT.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251617","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}
引用次数: 0
Cirrhosis and hyponatremia: A review of pathogenesis, clinical relevance, and management. 肝硬化和低钠血症:发病机制、临床相关性和治疗综述。
The American journal of the medical sciences Pub Date : 2025-06-03 DOI: 10.1016/j.amjms.2025.06.004
Jackeline Flores, Andrea Ortiz Maldonado, Camilo Pena, Kenneth Nugent
{"title":"Cirrhosis and hyponatremia: A review of pathogenesis, clinical relevance, and management.","authors":"Jackeline Flores, Andrea Ortiz Maldonado, Camilo Pena, Kenneth Nugent","doi":"10.1016/j.amjms.2025.06.004","DOIUrl":"10.1016/j.amjms.2025.06.004","url":null,"abstract":"<p><p>This narrative review examines the prognostic significance of sodium levels in cirrhosis. Clinical findings such as ascites typically develop between 5 and 10 years post-diagnosis, often with dysregulated sodium balance. About 50 % of cirrhosis patients develop hyponatremia, linked to poor prognosis, necessitating effective assessment and management. Hyponatremia arises from splanchnic vasodilation, causing fluid accumulation and reduced effective arterial volume, which triggers adaptive responses that worsen water retention and sodium imbalance. Ascitic fluid contains significant sodium stores, and its levels closely approximate serum values, suggesting that measuring ascitic sodium during therapeutic paracentesis might reduce the need for serum sampling. Management strategies include fluid restriction, vaptans, and albumin infusions, particularly in patients with acute kidney injury and ascites. Although pleural and peritoneal fluid analyses are routine, sodium levels are usually not measured despite their clinical relevance. This review addresses the pathophysiology, clinical implications, and management of hyponatremia in cirrhosis, focusing on patients with ascites or hepatic hydrothorax.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236354","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}
引用次数: 0
Endovascular Therapy in Acute Ischemic Stroke: A Six-Year National Assessment of Utilization and Outcomes: Outcomes of Endovascular Therapy in Acute Stroke. 急性缺血性脑卒中的血管内治疗:一项为期六年的全国评估:急性脑卒中血管内治疗的结果。
The American journal of the medical sciences Pub Date : 2025-06-03 DOI: 10.1016/j.amjms.2025.06.005
Abdul Rasheed Bahar, Yasemin Bahar, Syed Murtaza Ishaq, Abubakr Ziaullah, Prakash Upreti, Mohamed Alrayyashi, Olayiwola Bolaji, M Chadi Alraies
{"title":"Endovascular Therapy in Acute Ischemic Stroke: A Six-Year National Assessment of Utilization and Outcomes: Outcomes of Endovascular Therapy in Acute Stroke.","authors":"Abdul Rasheed Bahar, Yasemin Bahar, Syed Murtaza Ishaq, Abubakr Ziaullah, Prakash Upreti, Mohamed Alrayyashi, Olayiwola Bolaji, M Chadi Alraies","doi":"10.1016/j.amjms.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.06.005","url":null,"abstract":"<p><strong>Backgrounds: </strong>Ischemic stroke is a leading cause of death and disability worldwide. Endovascular treatment (EVT) is recognized as an effective intervention for acute ischemic stroke, but only a small fraction of patients with large vessel occlusion receive it. While EVT adoption has grown in the U.S., data on short- and long-term outcomes remain limited. This study aims to assess trends and in-hospital outcomes of stroke patients undergoing EVT.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database from 2016 to 2021. Adult patients hospitalized with LVO stroke involving the internal carotid or middle cerebral arteries were identified using ICD-10-CM codes and stratified by EVT status. Multivariable logistic regression and propensity score matching were used to adjust for baseline characteristics and evaluate in-hospital outcomes.</p><p><strong>Results: </strong>Among 840,335 hospitalizations with LVO stroke, 103,355 (13.3%) underwent EVT. In the PSM analysis of matched cohort (n=18,460), EVT was associated with higher in-hospital mortality (10.4% vs. 5.6%, p<0.001), intracerebral hemorrhage (18.58% vs. 9.82%, p<0.001), periprocedural stroke (0.16% vs. 0.08%, p=0.035), cardiac arrest (2.93% vs. 1.37%, p<0.001), and major adverse cardiac events (13.10% vs. 8.08%, p<0.001), acute kidney injury (15.59% vs. 14.76%, p=0.025) and arrhythmias (52.96% vs. 41.40%, p<0.001). Seizure incidence was lower in the EVT group (1.87% vs. 2.58%, p<0.001).</p><p><strong>Conclusions: </strong>Despite increased use of EVT, our study revealed that patients undergoing this intervention experienced higher in-hospital mortality and complication rates. These findings underscore the importance of patient selection and the need for further real-world studies to optimize EVT outcomes.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236355","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}
引用次数: 0
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