The American journal of the medical sciences最新文献

{"title":"Rebuilding the Head and Neck Exam in Medical Education.","authors":"Shervin Eskandari, Asim Ahmed, William J Healy","doi":"10.1016/j.amjms.2026.10.014","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.014","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291580","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":"Clinical Utility of Plasma Microbial Cell-Free DNA Sequencing in Adult Immunocompromised Patients: A Real-World Cohort Study.","authors":"Drew W Charles, Yosra Alkabab, Divisha Sharma, Ruth O Adekunle, Jillian Catalano, Rachel Colven, Scott R Curry, Susan E Dorman, Eric G Meissner, Alexandra Mills, Logan Patterson, Charles S Teixeria, Robert Sean Tyler, Cassandra D Salgado, Courtney E Harris","doi":"10.1016/j.amjms.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.011","url":null,"abstract":"<p><strong>Background: </strong>Plasma metagenomic next generation sequencing (mNGS) enables noninvasive pathogen detection independent of organism viability. Although analytic performance has been described, the real-world clinical impact in immunocompromised hosts remains incompletely defined.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of immunocompromised adults undergoing plasma mNGS testing from January 2022 through November 2024 at the Medical University of South Carolina. Immunocompromised conditions included solid organ transplantation, hematopoietic stem cell transplantation, active hematologic malignancy, HIV, or biologic immunosuppressants. Clinical impact was adjudicated by infectious disease physicians as positive, negative, or neutral. Positive results were classified as definite, probable, possible, or unlikely infectious based on clinical correlation and concordance with conventional microbiologic testing (CMT).</p><p><strong>Results: </strong>Ninety-eight patients were included (median age 60 years [range 18-76]; 63% male), including solid organ transplant (31%), hematopoietic stem cell transplant (8%), HIV (13%), active malignancy (42%), corticosteroids (3%), and biologic therapy (10%). At testing, 85% were receiving antimicrobials and 88% were hospitalized. Plasma mNGS was positive in 62% of cases, with CMT concordance in 30%. Thirty-two percent of tests had positive clinical impact, identifying unrecognized infection or antimicrobial optimization. Sixty-six percent had no treatment impact and 2% had potential negative impact. More than half of discordant positives were deemed possible or unlikely infections. False-negative cases included invasive mold and nontuberculous mycobacterial infections.</p><p><strong>Conclusions: </strong>In this antimicrobial-exposed immunocompromised cohort, plasma mNGS frequently detected organisms but less often influenced clinical management. Discordant positives were common, and false negatives occurred in selected syndromes, supporting cautious interpretation and stewardship-guided use.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291633","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":"Beyond Traditional Risk: Does Systemic Inflammation Drive Accelerated Atherosclerosis in Rheumatoid Arthritis?","authors":"Durlav Chowdhury, Maikala Muskan Rao, Rohan Sahu, Prashant Kumar Choubey, Kamta P Namdeo, Surendra H Bodakhe","doi":"10.1016/j.amjms.2026.10.012","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.012","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) is the primary cause of morbidity and mortality in individuals with rheumatoid arthritis (RA) and other rheumatic diseases (RDs), contributing to an approximate 50% increased cardiovascular risk relative to the general population. In addition to conventional cardiovascular risk factors, disease-specific processes such as chronic inflammation, endothelial dysfunction, and immunological dysregulation substantially accelerate atherosclerosis. This thorough analysis brings together the most recent information on how to measure cardiovascular risk, how to understand the underlying causes of RA and other rheumatic diseases, and how to treat them all together. In RA, long-term inflammation throughout the body causes atherosclerosis through several different mechanisms that are not related to common risk factors. To lower the risk of heart disease, rheumatologists, cardiologists, dietitians, physiotherapists, and immunologists must all work together. Evidence supports the targeting of disease activity, the management of conventional cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, and the use of non-pharmacological therapies.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291606","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":"Associations between Global Immune-Nutrition-Inflammation Index and Risk of Mortality in Intensive Care Unit Patients.","authors":"Guiyuan Li, Minxing Wang, Shenghua Zhuo, Haixiang Feng, Chenchen Cui, Jinhui Zhang, Zhen Liu","doi":"10.1016/j.amjms.2026.10.013","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.013","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective study aimed to evaluate the association between the newly developed Global Immune-Nutrition-Inflammation (GINI) index and the risk of all-cause mortality among patients admitted to the intensive care unit (ICU).</p><p><strong>Methods: </strong>Data were extracted from the Medical Information Mart for Intensive Care IV version 3.0 (MIMIC-IV-3.0) database. Associations between the GINI index and all-cause mortality were assessed using Kaplan-Meier survival curves and multivariate weighted Cox regression models. Additionally, restricted cubic spline (RCS) analyses were performed to explore potential non-linear relationships between the GINI index and hazard ratios (HRs). Subgroup analyses were conducted to evaluate possible interactions between the GINI index and selected clinical features.</p><p><strong>Results: </strong>A total of 970 patients were included, of whom 11.75% (N = 114) experienced all-cause mortality. A significant association was observed between a higher GINI index and increased risk of all-cause mortality. This association remained consistent when the GINI index was treated as a continuous variable (HR = 1.12; P = 0.03) and when categorized into groups (Group 2 vs. Group 1: HR = 1.97; P = 0.02; Group 3 vs. Group 1: HR = 2.17; P = 0.01). The RCS analysis supported a linear, rather than a non-linear, relationship between the GINI index and all-cause mortality (P > 0.05 for non-linearity).</p><p><strong>Conclusions: </strong>The GINI index is associated with elevated all-cause mortality risk among ICU patients and may serve as a promising candidate for mortality risk stratification, which highlights the potential benefit of timely targeted intervention.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291623","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":"Metabolic Burden, Metabolic Dysfunction-Associated Steatotic Liver Disease, and Cognitive Performance Among Older Adults: Analysis of 1,387 Participants from the National Health and Nutrition Examination Survey.","authors":"Mohammad Aldiabat, Yazan Aljabiri, Wesam Aleyadeh, Mohammed Essa, Ahmad Basil Nasir, Lewis J Frey, Adam D Farmer, Wing-Kin Syn","doi":"10.1016/j.amjms.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.009","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent in older adults, yet its independent contribution to cognitive decline beyond cardiometabolic risk factors remains uncertain.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of 1,387 NHANES 2011-2014 participants aged ≥60 years. MASLD was defined using hepatic steatosis index ≥36 plus ≥1 cardiometabolic risk factor, excluding excessive alcohol use. Cognitive performance across memory, verbal fluency, and processing speed was summarized as a global z-score composite. Advanced fibrosis likelihood was assessed using validated non-invasive scores. Weighted multivariable linear regression adjusted for demographic, lifestyle, and cardiometabolic covariates.</p><p><strong>Findings: </strong>MASLD was not associated with global cognition (β = 0.027; p=0.526) or individual domains after full adjustment. Advanced fibrosis risk was unrelated to cognition except for lower CERAD memory with high FIB-4 (β = -0.319; p=0.016). Greater metabolic risk factor burden showed graded associations with poorer cognition: ≥2 risk factors linked to lower global cognition (β = -0.23; p=0.036) and memory (β = -0.33; p=0.003); ≥3 showed borderline memory impairment (β = -0.24; p=0.049). In MASLD participants, ≥2 risk factors were associated with lower global cognition (β = -0.19; p=0.021) and ≥3 with reduced verbal fluency (β = -0.27; p=0.045). Processing speed declined only at highest metabolic burden in fibrosis-stratified models (e.g., DSST β = -0.51; p=0.015).</p><p><strong>Conclusion: </strong>MASLD and related fibrosis risk were not independently linked to cognitive impairment. Metabolic risk factor burden primarily drove poorer cognition, especially memory, in both the overall sample and those with MASLD, with processing speed affected only at the highest burden.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291639","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":"Conflicting Interpretations of Hereditary Cancer Genetic Tests.","authors":"Elizabeth M Yang, Christine E Park, Jason Y Park","doi":"10.1016/j.amjms.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.010","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149291577","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":"Beyond LDL-C: A Case-Based Review of Complex Dyslipidemia.","authors":"Nina Maria Fanaropoulou, Ron T Varghese","doi":"10.1016/j.amjms.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.008","url":null,"abstract":"<p><p>Dyslipidemia is clinically heterogeneous, and LDL-C alone may not fully capture atherogenic particle burden, metabolic risk, treatment response, or inherited disease. This case-based review presents three dyslipidemia phenotypes that illustrate common diagnostic and management challenges. The first case describes diet-sensitive LDL particle and lipoprotein insulin resistance changes despite LDL-C values near conventional targets in a patient with subclinical coronary atherosclerosis. The second highlights persistent low HDL-C and HDL particle number despite substantial LDL-C reduction with non-statin and incretin-era therapies in the setting of obesity and strong family history. The third demonstrates genetically confirmed familial hypercholesterolemia due to a pathogenic LDLR variant despite absent classic physical stigmata. Together, these cases support a phenotype-driven approach that integrates LDL-C, ApoB or LDL particle number, diet response, metabolic context, imaging, medication tolerance, and selective genetic testing to individualize dyslipidemia risk assessment and treatment.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248159","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":"Stercoral colitis may be more common than previously supposed - a study of prevalence in patients undergoing computed tomography for acute abdomen.","authors":"Johannes Gossner","doi":"10.1016/j.amjms.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.007","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149241035","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":"From Polycystic Ovary Syndrome to Polyendocrine Metabolic Ovarian Syndrome: A Practical Clinical Review.","authors":"Licy L Yanes Cardozo, Manar A Eissa, Jelina Basnet, Katie Thompson, Damian G Romero","doi":"10.1016/j.amjms.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.006","url":null,"abstract":"<p><p>Polycystic Ovary Syndrome (PCOS), recently renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS), is the most common endocrine disorder affecting women of reproductive age. The new nomenclature reflects growing recognition that this condition extends far beyond ovarian dysfunction, encompassing complex endocrine, metabolic, cardiovascular, and psychological abnormalities. Although the diagnostic criteria remain unchanged, the name change emphasizes the multisystem nature of the disorder and may improve disease recognition and patient care. This review provides a practical, evidence-based overview of the diagnosis and management of PMOS/PCOS, highlighting recent updates from the 2023 International Evidence-Based Guideline. We discuss the evaluation of hyperandrogenism and ovulatory dysfunction in reproductive-aged women, as well as the assessment and treatment of obesity, insulin resistance, type 2 diabetes mellitus, hypertension, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, obstructive sleep apnea, and mental health disorders. Finally, we summarize current pharmacological therapies and emerging treatment strategies, highlighting key knowledge gaps that must be bridged to optimize long-term cardiometabolic and reproductive outcomes.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149241084","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":"Octreotide Plus Proton pump inhibitor (PPI) versus PPI alone in Non-Variceal Upper gastrointestinal (GI) Bleeding in intensive care unit (ICU): A Multi-Center Randomized Trial.","authors":"Eman Ibrahim El-Desoki Mahmoud, Islam Ahmed Hassan Ellakany, Sally Wassfi Zaki Hammad, Nermeen Talaat Abd Elfatah","doi":"10.1016/j.amjms.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.005","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes between PPI therapy alone and PPI combined with octreotide in patients with acute upper gastrointestinal bleeding.</p><p><strong>Methods: </strong>This prospective, randomized, double-blind, multi-center study included 56 patients allocated to either PPI alone or PPI plus octreotide. Baseline demographics and comorbidities were comparable between groups. Laboratory parameters were assessed over three days. Clinical outcomes included rebleeding, transfusion requirements, mechanical ventilation, surgical intervention, ICU stay, hospital length of stay, and in-hospital mortality.</p><p><strong>Results: </strong>Prothrombin time was significantly higher in the PPI plus octreotide group (median 19 s vs 11.1 s; p=0.001), and urine output was significantly lower (p=0.011). Despite these differences, there were no significant differences in rebleeding rates, blood product transfusion, ICU stay, mechanical ventilation, or need for surgery. In-hospital mortality was significantly higher in the PPI plus octreotide group (39.3% vs 7%; p=0.011). Hospital length of stay was significantly shorter in the PPI plus octreotide group, likely reflecting higher early mortality rather than improved clinical recovery.</p><p><strong>Conclusions: </strong>The addition of octreotide to PPI therapy did not improve bleeding-related outcomes. Prolonged prothrombin time did not correlate with increased bleeding or transfusion needs. These findings suggest no clinical benefit of adjunctive octreotide in this study and underscore the importance of appropriate patient selection.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217802","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}