The American journal of the medical sciences最新文献

{"title":"Comparative Effectiveness and Safety of Self-Expanding Versus Balloon-Expandable Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.","authors":"Montaser Elkholy, Mohammad Akkawi, George G Kidess, Zaid Abdulelah, Abdallah Rayyan, Mohammad Riyad Al-Dqour, Ahmad Damlakhy, Yasemin Bahar, M Chadi Alraies","doi":"10.1016/j.amjms.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.010","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve replacement (TAVR) is a safe alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis at increased surgical risk. However, comparative data on self-expanding valves (SEV) versus balloon-expanding valves (BEV) remain limited.</p><p><strong>Methods: </strong>A comprehensive review of PubMed and Embase was conducted through April 2024, identifying eight studies (five randomized controlled trials and three propensity-matched observational studies) comparing SEV and BEV in TAVR. Primary outcomes included all-cause mortality, cardiovascular mortality, and device success per Valve Academic Research Consortium criteria, while secondary outcomes assessed bioprosthetic valve dysfunction and adverse events (annulus rupture/dissection, coronary artery occlusion, valve dislocation/embolization, valve thrombosis, moderate and severe paravalvular aortic regurgitation, endocarditis, permanent pacemaker implantation, major or life-threatening bleeding, acute kidney injury, and stroke).</p><p><strong>Results: </strong>The analysis included 4,032 patients (SEV = 2,006; BEV = 2,017). SEV was associated with higher rates of moderate-to-severe paravalvular aortic regurgitation [OR, 1.76; CI 1.13-2.74; P = 0.01] and permanent pacemaker placement [OR, 1.57; CI, 1.23-2.00; P = 0.0002] compared to BEV. No significant differences were observed in 30-day or 1-year all-cause mortality, cardiovascular mortality, device success, bioprosthetic valve dysfunction, valve dislocation/embolization, valve thrombosis, endocarditis, major or life-threatening bleeding, coronary artery occlusion, stroke, rehospitalization, or acute kidney injury.</p><p><strong>Conclusion: </strong>SEV and BEV demonstrated comparable outcomes in mortality and device success. However, the higher risk of moderate-to-severe paravalvular aortic regurgitation and permanent pacemaker placement with SEV should be considered when selecting the optimal TAVR valve for individual patients.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040381","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":"Corrigendum to \"Refeeding hypophosphatemia is a common cause of delirium in critically ill patients: A retrospective study\" [The American Journal of the Medical Sciences 369 (2025) 62-70].","authors":"Ying Xu, Yajun Qian, Pei Liang, Ning Liu, Danjiang Dong, Qin Gu, Jian Tang","doi":"10.1016/j.amjms.2025.04.012","DOIUrl":"10.1016/j.amjms.2025.04.012","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056479","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":"Uncommon cases of crescentic glomerulonephritis with preserved renal function at diagnosis: A retrospective case series from a single center.","authors":"Yanyan Zhang, Wei Wang, Guisen Li, Shasha Chen","doi":"10.1016/j.amjms.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.011","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to investigate the clinicopathologic characteristics, treatment and prognosis of crescentic glomerulonephritis (Crescentic GN) in patients with normal renal function at diagnosis, and compare to those with impaired renal function.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients with renal biopsy proven Crescentic GN at our center and divided them into normal eGFR group (eGFR≥60 ml/min/1.73 m²) and low eGFR group (eGFR <60 ml/min/1.73 m²). Clinical and renal pathological findings at diagnosis and renal outcomes were compared between the two groups using t-test, Wilcoxon rank sum test or Kruskal-Wallis H test.</p><p><strong>Results: </strong>From Jan 2010 to Dec 2021, 90 Crescentic GN patients with normal eGFR were included, in which clinicopathological diagnoses were LN (lupus nephritis) (60 cases, 66.77 %), IgAN (IgA nephropathy) (9 cases, 10 %), HSPN (Henoch-Schnlein purpura nephritis) (14 cases, 15.6 %) and AAV (ANCA-associated GN) (7 cases, 7.8 %). Compared with the low eGFR group (n = 300), the following characteristics were observed in the normal eGFR group: younger age (p < 0.001), female predominance (p < 0.001), longer time from onset to biopsy (p < 0.001), lower hypertension rate (p < 0.001), lower rate of oliguria (p < 0.001), and anemia (p < 0.001), lower levels of C3 (p < 0.001), C4 (p < 0.001) and Urine RBC (p < 0.001), higher titers of ANA (p < 0.001) and ds-DNA (p = 0.002), lower positive rate of ANCA (<0.001) and GBM (p = 0.02), less extra-renal involvement (p < 0.05), lower proportions of crescents (56.3(51.8-62.7) % vs 66.7 (56.3-81.3) %, p < 0.001) and glomerular sclerosis (p < 0.001), less severe tubulointerstitial lesion (p < 0.001) and interstitial inflammation (p < 0.001), higher degree of immune complex deposition of IgA, IgM, C3, C4 and C1q by Immunofluorescence. Normal eGFR group received lower frequency of intravenous methylprednisolone pulse therapy (71.2 % vs 89 %, p = 0.044) and dialysis treatment (0 % vs 53.7 %, p < 0.001). The 5- and 10-year cumulative renal survival rates from ESRD were 90.7 % vs 45.5 % and 58.3 % vs 43.7 %, respectively in normal and low eGFR group.</p><p><strong>Conclusion: </strong>Crescentic GN may present with normal renal function, which has poor renal outcomes and may benefit from intensive immunosuppressive treatment. This often occurs in patients with abnormal immunological indicators and systemic autoimmune disease. Shorter time from onset to biopsy may help better management and improve long-term outcomes in these cases. Renal biopsy remains the diagnostic gold standard when urinary abnormalities are present in nephritis.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040383","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 management of antiplatelet therapy in patients with coronary artery disease and thrombocytopenia.","authors":"Yalçın Velibey, Servet Altay, Osman Bolca","doi":"10.1016/j.amjms.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.007","url":null,"abstract":"<p><p>Ischemic heart disease is the leading cause of death in the world. Patients who have acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) with significant thrombocytopenia are at high risk for bleeding. In the literature, studies conducted on this patient group are very few. For this reason, although it is difficult for physicians to manage antiplatelet therapy in these patients, the risk of bleeding can be minimized with some current guideline recommendations. This review aims to explore in detail the management of antiplatelet therapy in patients who have moderate and severe thrombocytopenia with coronary artery disease (CAD).</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055682","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":"Longitudinal Trends in Heart Failure Mortality Linked to Coronary Artery Disease Among Adults 65 years and older.","authors":"Muhammad Abdullah Naveed, Sivaram Neppala, Muhammad Omer Rehan, Bazil Azeem, Himaja Dutt Chigurupati, Ahila Ali, Rabia Iqbal, Manahil Mubeen, Mushood Ahmed, Jamal Rana, Sourbha S Dani","doi":"10.1016/j.amjms.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.009","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) in patients with coronary artery disease (CAD) is a leading cause of mortality among older adults in the United States. This study examines trends in HF with CAD-related mortality among adults aged 65 and older.</p><p><strong>Methods: </strong>A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.</p><p><strong>Results: </strong>HF associated with CAD led to 1,597,451 deaths among adults > 65, primarily occurring in medical facilities (37.1%). The AAMR for HF with CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p < 0.001), which was significant from 1999 to 2014. Men had higher AAMRs than women (227.4 vs. 137.1), with women's rates declining more significantly (AAPC: -3.23, p < 0.001). White adults had the highest AAMRs (183.0), while Asians/Pacific Islanders (81.6) recorded the lowest. Geographically, AAMRs varied, from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1) CONCLUSION: Our study reveals striking disparities in HF-related mortality among adults aged 65 years and older in the United States. While AAMRs decreased overall from 1999 to 2014, they have reached an inflection point since 2019, indicating rising mortality rates. Persistent inequalities underscore the critical need for targeted public health interventions to address these issues.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015644","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":"Association of pemphigus vulgaris with infections in end-stage renal disease patients.","authors":"Sara Attari, Nadia Talebi, Jennifer L Waller, Stephanie L Baer, Wendy B Bollag","doi":"10.1016/j.amjms.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.005","url":null,"abstract":"<p><strong>Background: </strong>Pemphigus vulgaris is an autoimmune, blistering disease. The bullae of pemphigus vulgaris are characteristically flaccid and rupture easily leaving behind areas of exposed, unprotected tissue. Due to this compromise in the skin barrier, pemphigus vulgaris may be an independent risk factor for developing infections in end-stage renal disease (ESRD) patients, who are already at increased risk of infection.</p><p><strong>Methods: </strong>A retrospective cohort analysis of ESRD patients entered into the United States Renal Data System between 2004 and 2019 was conducted. We evaluated the association of pemphigus vulgaris and the infections bacteremia, septicemia, cellulitis, and herpes zoster in this population. ICD-9-CM and ICD-10-CM codes were used to determine pemphigus vulgaris and infection diagnoses. Logistic regression was used to examine the association of pemphigus vulgaris with each infection.</p><p><strong>Results: </strong>A total of 150 patients with a diagnosis of pemphigus vulgaris after the incident date of dialysis were identified. The unadjusted model demonstrated that patients with pemphigus vulgaris are at a significantly increased risk of developing bacteremia, septicemia, cellulitis, and herpes zoster compared to those without pemphigus vulgaris. After controlling for covariates the association was still greater than 1 for each infection; however, the p-values became non-significant. Diabetes was found to be a confounding variable for the association of pemphigus vulgaris and each infection.</p><p><strong>Conclusion: </strong>These results determined that in the ESRD population, after controlling for various demographic and clinical covariates, pemphigus vulgaris was not associated with increased risk of the queried infections.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055602","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":"Malignant cell count in pleural effusion: A potential indicator of mortality.","authors":"Celal Satici, Sinem Nedime Sokucu, Ibrahim Aras, Furkan Atasever, Damla Azakli, Halide Nur Urer","doi":"10.1016/j.amjms.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.003","url":null,"abstract":"<p><strong>Background: </strong>The role of malignant cell count in pleural fluid as a potential predictor of survival remains under investigation. This study aims to assess the relationship between malignant cell count in pleural effusion and mortality in patients with malignant pleural effusion (MPE).</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a tertiary referral and research hospital, including treatment-naive patients diagnosed with MPE. Univariate and multivariate Cox regression analyses were employed to identify independent predictors of mortality.</p><p><strong>Results: </strong>A total of 63 patients were included in the analysis, with a male predominance (39 males, 61.9 %) and a mean age of 65.7 ± 12.5 years. The majority (76.2 %) of patients had NSCLC. Patients were stratified based on malignant cell count into two groups: those with <1700 cells/2mm² and those with ≥1700 cells/2mm². The two groups were similar in demographics, blood and pleural fluid parameters, and comorbidities. Multivariate Cox regression analysis revealed that male gender (HR: 4.14, 95 % CI: 1.65-10.39), active smoking (HR: 2.99, 95 % CI: 1.25-7.16), and malignant cell count (HR: 0.23, 95 % CI: 0.09-0.56) were independent predictors of mortality.</p><p><strong>Conclusions: </strong>Our findings indicate that a malignant cell count of <1700 cells/2mm², male gender and active smoking are independent prognostic factors associated with increased mortality in patients with MPE. Further large-scale prospective studies are necessary to confirm the clinical relevance of cytological malignant cell counts and to explore the viability and functional significance of these cells.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059379","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 pressure and volume: mechanical power levels in a cohort of intensive care unit patients.","authors":"Jacob Harder, Kenneth Iwuji, Kenneth Nugent","doi":"10.1016/j.amjms.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.004","url":null,"abstract":"<p><strong>Background: </strong>Several ventilator parameters can be used to evaluate gas exchange and mechanical properties of the respiratory system in acute respiratory failure patients. The calculation of mechanical power (MP), a critical parameter that summarizes the energy transferred from the ventilator to the patient's lungs, is not routinely made in these patients.</p><p><strong>Methods: </strong>This study analyzed the distribution of MP in a cohort of 70 patients requiring mechanical ventilation and investigated its association with clinical outcomes.</p><p><strong>Results: </strong>This study included 39 men and 31 women with a mean age of 57.7 ± 15.1 years. The mean MP index decreased significantly from 10.4 J/min ± 5.65 on day 2 of mechanical ventilation to 8.3 J/min ± 4.1 on day 4 (p = 0.045). The mean length of mechanical ventilation was 5.2 ±6.5days. Mechanical power measured on day 2 (r = 0.317, p = 0.052) and day 4 (r = 0.352, p = 0.030) positively correlated with the duration of mechanical ventilation. There were no differences in MP between survivors and non-survivors on both day 2 (p = 0.458) and day 4 (p = 0.373).</p><p><strong>Conclusions: </strong>This study analyzed the distribution of MP levels in mechanically ventilated patients in an ICU. Mechanical power measured on days 2 and 4 of mechanical ventilation had a positive correlation with the duration of ventilation, but it was not a significant predictor of ICU mortality.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048727","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 potential role of SGLT2 inhibitors in the management of amyloidosis.","authors":"Bülent Özlek","doi":"10.1016/j.amjms.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.008","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061143","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 origins of ricin as a biowarfare agent in ancient India.","authors":"Ioannis Nikolakakis, Angeliki Geronymou, Spyros N Michaleas, Efthymia K Basdra, Marianna Karamanou","doi":"10.1016/j.amjms.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.amjms.2025.04.006","url":null,"abstract":"<p><p>Ricin, a highly potent toxin derived from Ricinus communis, has been recognized as both a therapeutic agent and a bioweapon throughout history. Its toxic mechanism, involving ribosomal inhibition, makes it lethal even in minuscule amounts. Historical references, including the book Arthashastra by Kauṭilya in ancient India (4th century BC), describe its strategic use in warfare, particularly resembling modern day gas attacks. Kauṭilya's text details methods of ricin-based poisoning through inhalation and ingestion, highlighting its early role as a bioweapon. The inclusion of other toxic plants and substances in these formulations reflects a sophisticated understanding of toxicology in antiquity. The use of ricin in modern bioterrorism attempts, along with its potential medical applications in targeted cancer therapies, underscores its dual nature. The persistence of ricin as a potential threat reinforces the need for continued vigilance and historical analysis to inform contemporary biosecurity measures.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059280","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}