The American journal of the medical sciences最新文献

{"title":"Association Between Lipoprotein A Levels and Vulnerable Atherosclerotic Plaques.","authors":"Arankesh Mahadevan, Himanshu S Jog, Hemanth Dhananjaya, Mansi Patel, Mehak Preet Singh Marwah, Murtaza H Gandhi, Srivatsa Surya Vasudevan, Sai Prasanna Lekkala, Hajra K Mehdi, Rupak Desai","doi":"10.1016/j.amjms.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.004","url":null,"abstract":"<p><strong>Background: </strong>Elevated lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor, but its association with imaging-defined vulnerable plaque features remains incompletely characterized.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus, and Embase for observational studies comparing elevated versus lower Lp(a) levels and reporting thin-cap fibroatheroma (TCFA) or lipid-rich plaques. Random-effects meta-analyses were performed, with the primary TCFA analysis restricted to optical coherence tomography (OCT)-based studies. Sensitivity and geography-based subgroup analyses were also conducted.</p><p><strong>Results: </strong>Seven studies involving 1,008 patients were included. Elevated Lp(a) was associated with greater odds of TCFA in the primary OCT-based analysis (OR 2.90, 95% CI 1.63 to 5.18; I²=51.0%) and with greater odds of lipid-rich plaques (OR 3.03, 95% CI 1.53 to 6.00; I²=76.9%). Including the MDCTA/MRI study in a TCFA sensitivity analysis yielded a similar association. No significant subgroup differences were observed between Asian and Western studies.</p><p><strong>Conclusions: </strong>Elevated Lp(a) is associated with imaging-defined features of plaque vulnerability, including TCFA and lipid-rich plaques. These findings should be interpreted cautiously given heterogeneity and the limited number of studies.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208395","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":"AKR1B1: a prognostic biomarker linking oxidative stress to apoptosis in adrenocortical carcinoma.","authors":"Xiangliang Tang, Dian Li, Tianxin Zhao, Kun Wei, Xiaoyong Pu","doi":"10.1016/j.amjms.2026.10.003","DOIUrl":"10.1016/j.amjms.2026.10.003","url":null,"abstract":"<p><strong>Background: </strong>Adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy with a poor prognosis. Oxidative stress, known to contribute to tumor progression, is believed to play a significant yet poorly understood role in ACC pathogenesis. The aims of this study were to construct a robust prognostic risk model for ACC based on oxidative stress-related genes and to experimentally investigate the functional impact of a key identified gene on oxidative stress and apoptosis.</p><p><strong>Methods: </strong>Using RNA sequencing data and clinical information from The Cancer Genome Atlas (TCGA) ACC cohort, GSE75415 and GSE33371, we identified and validated the prognostic oxidative stress-related risk signature. The risk model's predictive accuracy was assessed using Kaplan-Meier and ROC curve analyses. The tumor microenvironment and immune responses was performed by xCell and tumor immune dysfunction and exclusion (TIDE). Furthermore, in vitro experiments, including western blot, acridine orange/ethidium bromide (AO/EB) and oxidative stress index detection assays, were conducted to explore the roles of the pivotal gene, AKR1B1, in regulating apoptosis and oxidative stress.</p><p><strong>Results: </strong>We developed and validated a novel oxidative stress-related gene signature that effectively stratified ACC patients into high- and low-risk groups. The low-risk patients had better clinical overall survival and were predicted to have increased sensitivity to immunotherapy. Functional studies demonstrated that overexpression of AKR1B1 significantly alleviated H₂O₂-induced apoptosis and enhanced cellular antioxidant capacity.</p><p><strong>Conclusions: </strong>Our findings underscore the important functional role of AKR1B1 in inhibiting oxidative stress and apoptosis in ACC, highlighting it as a potential therapeutic target in ACC.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129716","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":"Mid-upper arm circumference as a universal peripheral proxy for whole-body adiposity distribution.","authors":"In Cheol Hwang, Hong Yup Ahn","doi":"10.1016/j.amjms.2026.10.002","DOIUrl":"10.1016/j.amjms.2026.10.002","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121321","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":"Management of Pulmonary Hypertension in Interstitial Lung Disease Without Access to Inhaled Treprostinil: A Case Series from a Resource-Limited Setting.","authors":"Pınar Akın Kabalak, Yasemin Söyler, Tuba İnal Cengiz, Murat Çelik, Ülkü Yılmaz","doi":"10.1016/j.amjms.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.10.001","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) may develop as a clinically important complication of parenchymal lung diseases, particularly in the setting of chronic hypoxemia and advanced interstitial lung disease. The management of interstitial lung disease-associated pulmonary hypertension (ILD-PH) remains challenging and requires a multidimensional assessment, including radiological findings, pulmonary function tests, comorbidities, and hemodynamic parameters.</p><p><strong>Objective: </strong>Although inhaled treprostinil is an approved treatment for ILD-PH, access to this therapy remains limited. We aimed to describe alternative management strategies and clinical outcomes in patients with ILD-PH in a resource-limited setting.</p><p><strong>Methods: </strong>This descriptive retrospective case series included four patients with different types of ILD: fibrotic hypersensitivity pneumonitis, combined pulmonary fibrosis and emphysema (CPFE), rheumatoid arthritis-associated ILD, and idiopathic pulmonary fibrosis (IPF). Demographic characteristics, hemodynamic data, treatment approaches, and clinical responses were evaluated.</p><p><strong>Results: </strong>Inhaled iloprost was initiated in patients with IPF and fibrotic hypersensitivity pneumonitis. Both patients tolerated the treatment well and remained functionally stable. However, the patient with CPFE was unable to tolerate inhaled prostanoid therapy and had a fatal outcome despite treatment with a phosphodiesterase-5 inhibitor. The patient with rheumatoid arthritis-associated ILD had severe fibrotic parenchymal involvement and demonstrated clinical stability during a 6-month follow-up period under phosphodiesterase-5 inhibitor therapy.</p><p><strong>Conclusion: </strong>Patients with ILD-PH should be evaluated individually according to underlying lung pathology, disease phenotype, and treatment tolerability. Where inhaled treprostinil is unavailable, alternative therapies, such as inhaled iloprost or phosphodiesterase-5 inhibitors, may provide clinical benefits in selected patients. However, patients with CPFE may have poorer outcomes despite PH-targeted therapies.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121224","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":"Weight loss diets and macronutrient intake in MASLD: A cross-sectional analysis of the U.S. population.","authors":"Matthew W Ewy, Elizabeth C Townsend, Adnan Said","doi":"10.1016/j.amjms.2026.09.004","DOIUrl":"10.1016/j.amjms.2026.09.004","url":null,"abstract":"<p><strong>Background: </strong>Key dietary patterns targeting Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) generally emphasize caloric restriction. However, dietary differences between individuals with and without MASLD remain unclear. This population-based cross-sectional study compares self-reported dietary patterns between individuals with and without MASLD in the US.</p><p><strong>Methods: </strong>We analyzed 2017-2018 National Health and Nutrition Examination Survey (NHANES) data on adults (≥18) with and without MASLD. Self-reported low-calorie diets versus no specific diet were examined. Dietary intake was assessed via 24-hour recalls.</p><p><strong>Results: </strong>The NHANES survey included 5856 adults, 1566 (26.7%) of whom met criteria for MASLD. Among MASLD participants, 11.2% (175/1566) reported following a low-calorie diet compared to 7.5% (180/2401) of non-MASLD controls (p < 0.001). Within the low-calorie group, MASLD participants reported higher caloric intake than controls (2159 vs. 1883 kcals; p = 0.004), carbohydrates (242 vs. 205 g; p < 0.001), and fat (90 vs. 76 g; p = 0.04). Among all adults with MASLD, caloric intake did not differ by diet status (low calorie dieters vs non-dieters) (2205 vs. 2159 kcals; p = 0.545) although the non-dieters consumed more sugar (114 vs. 93 g; p = 0.01) and the diet group consumed more sodium (3897 vs 3587 mg/d; p = 0.03).</p><p><strong>Conclusions: </strong>Among participants reporting low-calorie diets, MASLD participants consumed more calories, particularly from fats and carbohydrates, than non-MASLD controls. Nutrient profiles were similar regardless of dieting status in MASLD participants. These findings suggest that self-reported dietary adherence may not always reflect actual dietary intake. Given the central role of diet in MASLD outcomes, inconsistencies in dietary composition may partially explain variability in placebo responses observed in clinical trials. These findings need further confirmation to inform improvements in trial designs and intervention strategies.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009644","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 development of Clostridioides difficile Infection is associated with the severity of liver disease and worsens survival in acutely decompensated cirrhosis.","authors":"Ainhoa Fernández-Yunquera, Laura Carrión, Lucía Diéguez, Clara Villaseca, Andrés Conthe, Maricela Valerio, Mario Romero, Aranzazú Caballero, Fernando Díaz-Fontenla, Patricia Muñoz, Rafael Bañares, Diego Rincón","doi":"10.1016/j.amjms.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.09.003","url":null,"abstract":"<p><p>Clostridioides difficile infection (CDI) frequently occurs in advanced cirrhosis. We aimed to evaluate risk factors for CDI in acutely decompensated cirrhosis and its impact in relevant clinical outcomes METHODS: The study included patients with cirrhosis that were consecutively admitted for acute decompensation in a tertiary care hospital during a CDI outbreak. Data on admission, CDI ribotype, length of hospital stay, and 12-week survival were compared between patients with and without CDI. RESULTS: Twenty-nine out of 117 (24.7%). admitted patients developed CDI during hospitalization. Ribotype 027 was identified in 17 patients (58.6% of CDI cases). Patients with CDI had significantly worse baseline liver function, with higher MELD-sodium [19vs.14; p=0.002) and CLIF-C scores [56.6 vs. 52.0 p=0.04)] and were more frequently exposed to antibiotic therapy. Independent predictors of CDI included higher MELD-Na score [OR:1.13; p=0.002] and previous recent antibiotic use [OR: 4.93; p=0.001]. CDI was associated with a longer hospital stay [34 days (IQR 10-41) vs. 9 days (IQR 5-18); p=0.0001]. Although in-hospital mortality was similar between groups, age [OR: 1.08; (CI 95 %: 1.03- 1.13); p=0.001], MELD-sodium score [OR: 1.12 (CI 95 %:1.03 - 1.22); p=0.008], and ribotype 027 (OR: 4.25 , (CI 95 %:1.16 - 15.58); p=0.003] were independently associated with 12-week mortality. CONCLUSION: Severity of liver failure and recent exposure to antibiotics are risk factors for the development of CDI in acutely decompensated cirrhosis. CDI significantly increases 12-week mortality particularly in cases with the hypervirulent 027 ribotype strain.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009676","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":"\"Comment on: The association between cardiometabolic index and spondyloarthritis\".","authors":"Dua Jabbar, Ayesha Nasir Khan, Saleh Mohammad Shah, Deepa Kumari, Baby Nisha","doi":"10.1016/j.amjms.2026.09.002","DOIUrl":"10.1016/j.amjms.2026.09.002","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972282","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 association between the healthy eating index and all-cause mortality in U.S. patients with chronic kidney disease: Evidence from NHANES.","authors":"Mei Yuan, Yueyuan Hou, Luohua Li","doi":"10.1016/j.amjms.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.08.006","url":null,"abstract":"<p><strong>Background: </strong>Epidemiological evidence on the relationship between the Healthy Eating Index (HEI-2015) and mortality in chronic kidney disease (CKD) populations is limited. This study aimed to assess the association between HEI-2015 scores and all-cause mortality in CKD patients.</p><p><strong>Methods: </strong>This cohort study included 7,360 CKD patients using data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018, with follow-up until December 31, 2019. All-cause mortality was determined using National Death Index (NDI) records. We applied weighted Cox regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) between HEI-2015 and all-cause mortality.</p><p><strong>Results: </strong>Over a median follow-up of 78 months, 2,437 CKD patients died from all causes. After adjusting for confounders, individuals in the highest tertile of HEI-2015 scores had a lower risk of all-cause mortality compared to those in the lowest tertile, with an HR of 0.55 (95% CI: 0.34-0.89). Additionally, each standard deviation increase in HEI-2015 was associated with an HR of 0.73 (95% CI: 0.60-0.90) for all-cause mortality. Kaplan-Meier survival and restricted cubic regression spline analyses revealed a significant negative correlation between HEI-2015 and mortality risk (P<0.05), which was supported by sensitivity analysis.</p><p><strong>Conclusions: </strong>Higher HEI-2015 scores are significantly associated with a reduced risk of mortality in CKD patients, highlighting the importance of improving HEI-2015 scores in high-risk CKD populations to reduce mortality risk.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922477","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":"Comprehensive geriatric assessment in older adults with rheumatoid arthritis: A pilot cross-sectional study.","authors":"Suzan Abou-Raya, Eman Abdelghani, Mohamed Arafa, Mohamed Eldihy, Anna Abou-Raya","doi":"10.1016/j.amjms.2026.08.026","DOIUrl":"10.1016/j.amjms.2026.08.026","url":null,"abstract":"<p><strong>Background: </strong>Older adults with rheumatoid arthritis (RA) frequently present with multiple comorbidities and geriatric syndromes (GS), complicating disease management and increasing vulnerability. Comprehensive geriatric assessment (CGA) is a multidimensional approach evaluating functional, physical, cognitive and psychosocial domains, providing a holistic framework for patient-centered care.</p><p><strong>Aim: </strong>To assess the utility of CGA in identifying multidomain impairments and healthcare needs in older adults with RA and to explore the relationship between comorbidity burden, GS, disease activity and functional status.</p><p><strong>Methods: </strong>This cross-sectional observational study included 100 patients aged ≥65 years fulfilling ACR/EULAR RA criteria. Sociodemographic and clinical data were collected, including pain, fatigue, mobility, nutrition, continence, sensory function, falls, sleep, comorbidities and medication use. All participants underwent musculoskeletal examination, disease activity assessment, and a comprehensive 60-90-minute CGA.</p><p><strong>Results: </strong>The mean age was 69.9 ± 3.9 years, and 52% were female. The mean Charlson Comorbidity Index (CCI) was 3.24 ± 1.58 and correlated significantly with disease activity (r = 0.207, p = 0.039). Fatigue, pain and functional disability were highly prevalent. Polypharmacy (≥5 medications) was observed in 67% of patients. Cognitive impairment (67%), depression (64%), urinary incontinence (68%) and sleep disturbance (70%) were common. Frailty status was robust in 10%, pre-frail in 57%, and frail in 33%, with 26% reporting falls. CGA identified significant multidomain deficits.</p><p><strong>Conclusions: </strong>Older adults with RA exhibit substantial hidden vulnerabilities and high comorbidity burden. Integration of CGA into routine care may improve risk stratification, optimize management, enhance medication safety and reduce functional decline within multidisciplinary care settings.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883183","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":"2026 SSCI Founders' Medal Presentation and Acceptance: Dr. Kenneth Nugent.","authors":"S Calvin Thigpen, Kenneth Nugent","doi":"10.1016/j.amjms.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.amjms.2026.09.001","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883211","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}