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The "Fixed period," the wildfire news, and an unpublished manuscript: Osler's farewell speech revisited in geographical breadth and emotional depth.
The American journal of the medical sciences Pub Date : 2025-02-11 DOI: 10.1016/j.amjms.2025.02.005
Maren Anderson, R Hal Scofield
{"title":"The \"Fixed period,\" the wildfire news, and an unpublished manuscript: Osler's farewell speech revisited in geographical breadth and emotional depth.","authors":"Maren Anderson, R Hal Scofield","doi":"10.1016/j.amjms.2025.02.005","DOIUrl":"10.1016/j.amjms.2025.02.005","url":null,"abstract":"<p><p>William Osler, the founding Chair of Medicine at the Johns Hopkins College of Medicine, left for Oxford in 1905. He delivered a valedictory lecture February 1905 at Johns Hopkins in which he referred to a novel by Anthony Trollope called The Fixed Period. Osler stated that almost all important work was done prior to the age of 40 and the retirement age should be 60, at least for professors. In jest, he said that perhaps men should be euthanized by chloroform at age 60, which he recalled as the plot of the novel. The so-called Fixed Period address created a media controversy with numerous articles decrying Osler. Osler's reaction to the controversy has not been commonly documented. We examined an unpublished manuscript by Osler's student Francis Packard that contributes to the knowledge of Osler's feeling about The Fixed Period address and the reaction to it. In addition, for the first time we examine the extent and geography of newspaper articles about Olser's Fixed Period address.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416598","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
The effect of Empagliflozin on alleviating C4d over-activation in Diabetic kidney disease. Empagliflozin 对缓解糖尿病肾病患者 C4d 过度激活的影响
The American journal of the medical sciences Pub Date : 2025-02-10 DOI: 10.1016/j.amjms.2025.02.002
Ahmed Fayed, Ahmed Fathy, Nehal Kamal Rakha, Karim M Soliman, Hany Hammad
{"title":"The effect of Empagliflozin on alleviating C4d over-activation in Diabetic kidney disease.","authors":"Ahmed Fayed, Ahmed Fathy, Nehal Kamal Rakha, Karim M Soliman, Hany Hammad","doi":"10.1016/j.amjms.2025.02.002","DOIUrl":"10.1016/j.amjms.2025.02.002","url":null,"abstract":"<p><strong>Background: </strong>Empagliflozin was associated with a slower progression of kidney disease. We aimed to investigate the effect of empagliflozin on alleviating complement over-activation in DKD.</p><p><strong>Methods: </strong>100 patients with DKD were recruited, they were divided into three groups: group I, 50 patients type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD) stage I-II; group II, 50 patients T2DM with CKD stage III; and the control group, which included 50 healthy, age-matched volunteers. Groups I and II received empagliflozin, while Group III received a placebo. Before and after six months on empagliflozin, the patients in both groups underwent tests for serum creatinine, uric acid, fasting blood glucose (FBG), glycated hemoglobin (HbA1c) urine albumin/creatinine ratio, and blood levels of human complement fragment 4d (C4d).</p><p><strong>Results: </strong>The optimal cut off value of C4d was ascertained to be 17.55 U/L with a sensitivity of about 68 % and specificity of about 68 %. There were statistically significant differences in Group I after empagliflozin treatment (p < 0.001): HbA1c (6.5 to 5.7), C4d (16 to 7U/l). Whereas serum creatinine (1.9 to 1.7mg/dl), HbA1c (9.9 to 6.7 %), urine albumin/creatinine ratio (115 to 49), and C4d (18 to 11U/l) were significantly improved in Group II after using empagliflozin (p < 0.001). There was a negative correlation between C4d levels and the percent change in uric acid (r -0.647-, p < 0.001).</p><p><strong>Conclusion: </strong>Empagliflozin may have a beneficial effect on mitigating complement over-activation in DKD. Further research is needed to confirm our findings.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412228","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
Facial metastasis of Esophageal squamous cell carcinoma. 食管鳞状细胞癌的面部转移
The American journal of the medical sciences Pub Date : 2025-02-10 DOI: 10.1016/j.amjms.2025.02.003
Sen-Ei Shai, Hung-Ju Kuo, Yi-Ling Lai, Chi-Wei Hsieh
{"title":"Facial metastasis of Esophageal squamous cell carcinoma.","authors":"Sen-Ei Shai, Hung-Ju Kuo, Yi-Ling Lai, Chi-Wei Hsieh","doi":"10.1016/j.amjms.2025.02.003","DOIUrl":"10.1016/j.amjms.2025.02.003","url":null,"abstract":"<p><p>Esophageal squamous cell carcinoma (SCC) is a highly lethal malignancy with a low survival rate, often presenting at an advanced stage. Cutaneous metastasis from esophageal SCC is exceedingly rare, affecting less than 1 % of cases, and is associated with a poor prognosis. This review particularly focuses on facial metastasis and discusses the clinical presentation, diagnostic challenges, and management of cutaneous metastases. The variability in clinical presentation often leads to misdiagnosis, delaying appropriate treatment. Histopathological examination and immunohistochemical staining are crucial for accurate diagnosis. Management involves a combination of local and systemic therapies, tailored to the patient's overall health and disease extent. This topic emphasizes the need for vigilance and thorough diagnostic workups in patients with unusual skin lesions and highlights the importance of multidisciplinary care in optimizing treatment outcomes for patients with advanced esophageal cancer.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412227","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
Combined pulmonary fibrosis and emphysema: From radiology to reality - Rethinking progression and prognosis.
The American journal of the medical sciences Pub Date : 2025-02-08 DOI: 10.1016/j.amjms.2025.02.004
Valeria Santibanez
{"title":"Combined pulmonary fibrosis and emphysema: From radiology to reality - Rethinking progression and prognosis.","authors":"Valeria Santibanez","doi":"10.1016/j.amjms.2025.02.004","DOIUrl":"10.1016/j.amjms.2025.02.004","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392795","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
Noninvasive ventilation for respiratory failure: When does it work and when it does not?
The American journal of the medical sciences Pub Date : 2025-02-04 DOI: 10.1016/j.amjms.2025.02.001
Yiran Gong, Anoosha Ponnapalli, Kausar Hafeez, Ayman O Soubani
{"title":"Noninvasive ventilation for respiratory failure: When does it work and when it does not?","authors":"Yiran Gong, Anoosha Ponnapalli, Kausar Hafeez, Ayman O Soubani","doi":"10.1016/j.amjms.2025.02.001","DOIUrl":"10.1016/j.amjms.2025.02.001","url":null,"abstract":"<p><p>Noninvasive positive pressure ventilation (NIV) is a positive pressure ventilation method employed across various disease processes, utilizing noninvasive interfaces such as helmets and facemasks rather than invasive methods such as endotracheal intubation. The benefits of NIV are significant in both the acute care setting, such as improving work of breathing and avoiding the need for endotracheal intubation, as well as in the chronic care setting, improving quality of life and mortality. While new guidelines broaden the application of NIV across various disease areas and introduce emerging modalities, uncertainty persists regarding the appropriate timing and circumstances for NIV utilization. We present a detailed review of the literature with up-to-date studies assessing the indications and limitations of NIV in a variety of conditions associated with acute and chronic respiratory failure. The review also summarizes the current guidelines on the use of NIV in the acute care setting. Although primarily targeted towards the acute indications of NIV, we believe this review will aid in better understanding and managing noninvasive ventilation for clinicians across both the inpatient and outpatient settings.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367206","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 appraisal in protracted heart failure.
The American journal of the medical sciences Pub Date : 2025-01-31 DOI: 10.1016/j.amjms.2025.01.009
Marjorie Flores Chang, Rohan Samson, Amitabh Pandey, Thierry H Le Jemtel
{"title":"Therapeutic appraisal in protracted heart failure.","authors":"Marjorie Flores Chang, Rohan Samson, Amitabh Pandey, Thierry H Le Jemtel","doi":"10.1016/j.amjms.2025.01.009","DOIUrl":"10.1016/j.amjms.2025.01.009","url":null,"abstract":"<p><p>Data from pivotal randomized controlled trials established the four pillars of guideline-directed medical therapy in heart failure with reduced ejection fraction. The randomized controlled trials enrolled stable patients with New York Heart Association functional class II-III and a low incidence of cardiovascular death and hospitalization for heart failure. Whether the four pillars retain therapeutic value when a patient's symptoms worsen and life expectancy decreases has received scarce attention. We review the observational studies that point to the fading benefit of neurohormonal modulation and cardiac afterload reduction in the late stages of cardiovascular or renal diseases. We then propose a pragmatic approach for collecting evidence-based data on sequential withdrawal of the four pillars in patients with heart failure and reduced ejection fraction after years of guideline-directed medical therapy.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082457","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
A decade in disguise masquerading as recurrent pneumonia.
The American journal of the medical sciences Pub Date : 2025-01-31 DOI: 10.1016/j.amjms.2025.01.010
Dr Aneri Parekh, Dr Pritinanda Mishra, Dr Mahismita Patro, Dr Sourin Bhuniya, Dr Siddharth Singh, Dr Supantha De
{"title":"A decade in disguise masquerading as recurrent pneumonia.","authors":"Dr Aneri Parekh, Dr Pritinanda Mishra, Dr Mahismita Patro, Dr Sourin Bhuniya, Dr Siddharth Singh, Dr Supantha De","doi":"10.1016/j.amjms.2025.01.010","DOIUrl":"10.1016/j.amjms.2025.01.010","url":null,"abstract":"<p><p>Primary pulmonary lymphoma (PPL) is a rare type of lymphoma, representing <1 % of all primary lung cancers. Mucosa associated lymphoid tissue (MALT) lymphoma, the most common type of PPL, has an indolent slow growing course over years leading to frequent misdiagnoses. We report a similar case of a 45 years-old-man with a protracted course of intermittent cough and dyspnoea, masquerading as recurrent pneumonia over 10 years. A dig into his prior records revealed consolidation of right lower lobe that had slowly progressed to involve other lobes with new cavitation. A transthoracic biopsy confirmed it as MALT lymphoma. This case highlights the unusual manifestation in MALT lymphoma (being in disguise for a decade prior to diagnosis), thus emphasizing the role of meticulous evaluation of prior medical records and biopsy.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082400","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
Research in academic medicine - Just another rich getting richer story?
The American journal of the medical sciences Pub Date : 2025-01-28 DOI: 10.1016/j.amjms.2025.01.008
Don C Rockey
{"title":"Research in academic medicine - Just another rich getting richer story?","authors":"Don C Rockey","doi":"10.1016/j.amjms.2025.01.008","DOIUrl":"10.1016/j.amjms.2025.01.008","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070574","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
The association between county-level social determinants of health and cardio-kidney-metabolic disease attributed all-cause mortality in the US: A cross sectional analysis.
The American journal of the medical sciences Pub Date : 2025-01-21 DOI: 10.1016/j.amjms.2025.01.007
Antoinette Cotton, Pedro Rvo Salerno, Salil V Deo, Salim S Virani, Khurram Nasir, Ian Neeland, Sanjay Rajagopalan, Naveed Sattar, Sadeer Al-Kindi, Yakov E Elgudin
{"title":"The association between county-level social determinants of health and cardio-kidney-metabolic disease attributed all-cause mortality in the US: A cross sectional analysis.","authors":"Antoinette Cotton, Pedro Rvo Salerno, Salil V Deo, Salim S Virani, Khurram Nasir, Ian Neeland, Sanjay Rajagopalan, Naveed Sattar, Sadeer Al-Kindi, Yakov E Elgudin","doi":"10.1016/j.amjms.2025.01.007","DOIUrl":"10.1016/j.amjms.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>The American Heart Association recently defined cardio-kidney-metabolic (CKM) syndrome as the intersection between metabolic, renal, and cardiovascular disease. Understanding the contemporary estimates of CKM related mortality in the US is essential for developing targeted public interventions.</p><p><strong>Methods: </strong>We analyzed state-level and county-level CKM-associated all-cause mortality data (2010-2019) from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER). Median and interquartile (IQR) age-adjusted mortality rates (aaMR) per 100,000 were reported and linked with a multi-component metric for social deprivation: the Social Deprivation Index (SDI: range 0 - 100) grouped as: I: 0 - 25, II: 26 - 50, III: 51 - 75, and IV: 75 - 100. We fit pairwise comparisons between SDI groups and evaluated aaMR stratified by sex, race, and location.</p><p><strong>Results: </strong>In 3101 counties, pooled aaMR was 505 (441-579). Oklahoma (643) and Massachusetts (364) had the highest and lowest values. aaMR increased across SDI groups [I: 454(404, 505), IV: 572(IQR: 495.9, 654.7); p < 0.001]. Men had higher rates [602 (526, 687)] than women [427 (368, 491)]. Metropolitan [476 (419, 542)] had lower rates than non-metropolitan counties [521 (454, 596)]. Non-Hispanic Black [637 (545, 731)] had higher rates than non-Hispanic White residents [497 (437, 570]. CKM associated aaMR remained reasonably constant between 2010 and 2019 (Mann Kendall test for trend p-value = 0.99).</p><p><strong>Conclusions: </strong>In the US, CKM mortality disproportionately affects more socially deprived counties. Inability to reduce CKM mortality rates over the study period highlights the need for targeted policy interventions to curb the ongoing high burden.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030610","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
Thyroid hormones in systemic lupus erythematosus: The catalyst for disease progression? 系统性红斑狼疮的甲状腺激素：疾病进展的催化剂？
The American journal of the medical sciences Pub Date : 2025-01-14 DOI: 10.1016/j.amjms.2025.01.006
Qiu-Rui Li, Lin-Lin Li, Yang Dong, Hui-Xia Cao
{"title":"Thyroid hormones in systemic lupus erythematosus: The catalyst for disease progression?","authors":"Qiu-Rui Li, Lin-Lin Li, Yang Dong, Hui-Xia Cao","doi":"10.1016/j.amjms.2025.01.006","DOIUrl":"10.1016/j.amjms.2025.01.006","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to investigate the impact of varying thyroid function statuses on clinical and laboratory indicators in patients with systemic lupus erythematosus (SLE).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 258 patients with SLE, who were stratified according to thyroid function, renal involvement, and disease activity. The predictive value of thyroid hormones was evaluated using a receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Among the 258 patients with SLE, 141 were classified as the normal group, while 117 exhibited thyroid hormone abnormalities, categorized into hypothyroidism (N=112) and hyperthyroidism (N=5) groups. Serum levels of FT3 and FT4 positively correlate with total protein and albumin, while negatively correlating with the SLE Disease Activity Index 2K (SLEDAI-2K) and 24-hour urinary protein (24hUP) (P<0.05). Compared to individuals without renal involvement, those with renal involvement exhibited lower levels of FT3 and FT4 (3.35±0.99 vs. 4.07±2.22, 12.92±3.14 vs. 14.63±3.39, P=0.001), along with elevated thyroid-stimulating hormone (TSH) levels (7.08±14.40 vs. 5.28±12.48, P=0.343). The subgroups in euthyroid (n=86) and hypothyroid (n=93) of SLE patients with renal involvement exhibited different characteristics (P<0.05). The levels of FT3 gradually decreased with increase of disease activity. The areas under the ROC curve of FT3, FT4, TSH and their combination were 0.651, 0.654, 0.643, 0.669, respectively (P<0.05).</p><p><strong>Conclusions: </strong>The correlation between thyroid function and the severity of SLE is significant, SLE patients with hypothyroidism exhibit more pronounced disease manifestations and an elevated risk of organ damage. SLE patients with low levels of FT3 and FT4 are prone to progressing to nephritis.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019350","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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