The American journal of the medical sciences最新文献

{"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}

{"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295562","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}

{"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}

{"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 (CB₁R) expression has been reported in the lungs of patients who died from COVID-19 pneumonia. Multiple studies indicate that CB₁R overactivation exacerbates inflammation and tissue disrepair in mice, and the level of anandamide (AEA), an endogenous CB₁R 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/CB₁R 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}

{"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}

{"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}

{"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}

{"title":"Pathogenesis and treatments for high altitude pulmonary hypertension: An updated review.","authors":"Yuying Tan, Jie Dai, Bi Ran, Qingqing Su, Fengming Luo, Lei Chen","doi":"10.1016/j.amjms.2025.06.001","DOIUrl":"10.1016/j.amjms.2025.06.001","url":null,"abstract":"<p><p>High altitude pulmonary hypertension (HAPH) is a specific type of pulmonary hypertension, caused by chronic exposure to hypobaric hypoxic environment in highlands. Recently, some important studies regarding the pathogenesis and treatments for HAPH have been published. Based on these latest publications, we performed an updated review focusing on the pathogenesis and treatments for HAPH.</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":"144236356","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":"Trends and outcomes of atrial fibrillation patients with thrombocytopenia: Insights from the national inpatient sample.","authors":"Ahmed M Younes, Ahmed K Mahmoud, Ibrahim Kamel, Ahmed Maraey, Mahmoud Khalil","doi":"10.1016/j.amjms.2025.05.008","DOIUrl":"10.1016/j.amjms.2025.05.008","url":null,"abstract":"<p><strong>Background: </strong>Anticoagulation may be indicated for the management of atrial fibrillation (AF) to mitigate thromboembolic risk. Thrombocytopenia in patients with AF may influence clinical outcomes. This study aims to evaluate the impact of thrombocytopenia on inpatient outcomes in AF patients.</p><p><strong>Methods: </strong>Using the National Inpatient Sample (NIS) (2016-2020), patients with AF were identified using the appropriate ICD-10 codes. Outcomes were compared between patients with and without thrombocytopenia. Logistic and linear regression analyses were performed after adjusting for possible confounders. The primary outcome was all-cause inpatient mortality. Secondary outcomes included trends of thrombocytopenia prevalence and mortality in AF patients, major bleeding, hypovolemic shock, packed red blood cell (pRBC) transfusion, ischemic cerebrovascular accident, length of stay, and total charges.</p><p><strong>Results: </strong>A total of 2,016,244 adult patients with AF were identified with 75,545 (3.8 %) having thrombocytopenia. Thrombocytopenia was associated with increased mortality (adjusted odds ratio [aOR] 2.59, 95 % confidence interval [CI] 2.31-2.89, P < 0.001), major bleeding (aOR 2.15, 95 % CI 1.95-2.37, P < 0.001), hypovolemic shock (aOR 3.44, 95 % CI 2.53-4.66, P < 0.001), pRBC transfusion (aOR 3.43, 95 % CI 3.12-3.76, P < 0.001), length of stay (adjusted mean difference [aMD] 1.60 days, 95 % CI 1.51 - 1.69, P < 0.001), and total charges (aMD $17,895, 95 % CI 16,194-19,595, P < 0.001).</p><p><strong>Conclusions: </strong>Thrombocytopenia is associated with significantly increased mortality, bleeding complications, and resource utilization in patients with AF. These findings highlight the importance of careful management of AF in this population.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228181","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":"Sex differences in trends and outcomes among patients with septic shock in the United States.","authors":"Song Peng Ang, Jia Ee Chia, Bryan Gregory, Jose Iglesias","doi":"10.1016/j.amjms.2025.05.010","DOIUrl":"10.1016/j.amjms.2025.05.010","url":null,"abstract":"<p><strong>Background: </strong>Despite substantial progress in early recognition and treatment, sepsis mortality rates continue to be high. The role of sociodemographic factors, such as sex, in outcomes among septic shock remains underexplored. We aimed to evaluate the trend and sex-specific outcomes in septic shock using a nationally representative database.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the National Inpatient Sample (NIS) from 2016 to 2021. Adult patients (≥18 years) with septic shock were identified using ICD-10-CM codes. The primary outcome was in-hospital mortality. Multivariate logistic regression was used to adjust for demographic factors, hospital characteristics, and comorbidities.</p><p><strong>Results: </strong>Among 3504,269 hospitalizations, 52.7 % were men, with septic shock hospitalizations increasing significantly for both sexes over the study period. Men experienced higher in-hospital mortality (34.3 % vs. 32.8 %, p < 0.001) and AKI (69.0 % vs. 64.7 %, p < 0.001). Multivariate analysis revealed lower mortality odds in women than men (adjusted Odds Ratio 0.985, 95 % CI 0.975-0.996, p = 0.008), even after adjusting for comorbidities. Trends demonstrated a sharp increase in mortality beginning in 2020, coinciding with the COVID-19 pandemic.</p><p><strong>Conclusions: </strong>Women with septic shock demonstrate lower odds of mortality and complications compared to men, highlighting potential protective factors or differences in clinical presentation. The sharp rise in mortality during the COVID-19 pandemic emphasizes the need for further research into the intersection of sex, race, and systemic factors affecting outcomes.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210608","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}