The American journal of the medical sciences最新文献

{"title":"The evolving burden of hepatitis B and C: Past trends and future projections from the global burden of disease study 2021.","authors":"Yue Chen, He-Hui Mao, Ming-Jing Zhang, Jin-Yan Zhang, Xue-Qin Chen, Wei-Feng Huang","doi":"10.1016/j.amjms.2026.08.024","DOIUrl":"10.1016/j.amjms.2026.08.024","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis B and C continue to pose significant challenges to global public health, and this study is aimed at evaluating their burden.</p><p><strong>Methods: </strong>Leveraging data from the Global Burden of Disease 2021, we analyzed age-standardized mortality rates (ASMRs) and age-standardized disability-adjusted life year rates (ASDRs) for hepatitis B and C from 1990 to 2021 using Joinpoint regression, age-period-cohort models, and decomposition analysis. Bayesian age-period-cohort models were applied to project future trends up to 2036. Additionally, we assessed the burden attributable to modifiable risk factors and its association with socioeconomic indicators.</p><p><strong>Results: </strong>From 1990 to 2021, the global ASMR for hepatitis B declined from 12.19 to 7.57 per 100,000, and the ASMR for hepatitis C decreased from 8.18 to 6.10 per 100,000. Despite these decreases, the absolute numbers of deaths and DALYs continued to increase, mainly driven by population growth and aging. In 2021, males carried a disproportionately higher burden of hepatitis B and C compared to females. Moreover, countries with low socioeconomic development faced a greater burden. Notably, high alcohol consumption accounted for 16.20% of hepatitis B DALYs, while drug use was responsible for 49.49% of hepatitis C DALYs. By 2036, ASMRs are projected to decline further to 5.90 per 100,000 for hepatitis B and 5.23 per 100,000 for hepatitis C.</p><p><strong>Conclusions: </strong>Although ASMRs and ASDRs have declined, the global burden of hepatitis B and C remains considerable. Continued efforts in vaccination, antiviral treatment, and control of key risk factors are crucial, especially in populations with a high burden.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860656","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 of biological aging and biological age acceleration with mortality in patients with cardiorenal syndrome: A prospective cohort study.","authors":"Xintong Yang, Yurong Zhang, Yang Zhong, Zhen Li, Xiaorong Yang, Tongchao Zhang, Ming Lu","doi":"10.1016/j.amjms.2026.08.025","DOIUrl":"10.1016/j.amjms.2026.08.025","url":null,"abstract":"<p><strong>Background: </strong>Cardiorenal syndrome (CRS), characterized by cardiac-renal interplay, imposes a substantial clinical burden. Biological aging (BA), a comprehensive indicator for evaluating the overall aging status of an organism, is linked to individual cardiac or renal diseases, while its association with mortality in the CRS population remains unclear.</p><p><strong>Methods: </strong>We utilized data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. CRS was defined as chronic cardiorenal comorbidities, specifically the coexistence of self-reported cardiovascular disease and calculated chronic kidney disease. BA was calculated using 12 clinical biomarkers, including the Klemera-Doubal method BA (KDM-BA) and Phenotypic Age (PhenoAge). BA acceleration (BAA), quantified as residuals from linear regression of BA on chronological age, includes KDM-BAA and PhenoAge acceleration (PhenoAgeAccel). Cox proportional hazards model and restricted cubic spline were performed to investigate these associations. Results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>1100 CRS participants were included in the final analysis. A 10-year increase in KDM-BA and PhenoAge in CRS participants was associated with 1.14-fold and 1.63-fold higher all-cause mortality risk, respectively. CRS participants with KDM-BAA (HR: 1.40, 95% CI: 1.13-1.73) or PhenoAgeAccel (HR: 1.54, 95% CI: 1.20-1.96) had elevated all-cause mortality risk. Meanwhile, these positive associations were more pronounced in males. Moreover, KDM-BA was associated with mortality from heart disease and cerebrovascular disease in the CRS population, with a non-linear relationship observed in cerebrovascular disease.</p><p><strong>Conclusions: </strong>As composite indicators for aging, KDM-BA, PhenoAge, KDM-BAA, and PhenoAgeAccel are significantly associated with all-cause mortality among the CRS population. These measures may serve as potential prognostic biomarkers in this population.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857724","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 monotherapy: The evolving role of CTLA-4 in combination immunotherapy for gastrointestinal cancers.","authors":"Fuyuan Ma, Jingyuan Ma, Yaofan Lu, Jingxuan Xu, Jiale Mao, Ziyue Yin, Zikun Ni, Xueqin Zhao, Biao Huang, Yuan Qin","doi":"10.1016/j.amjms.2026.08.023","DOIUrl":"10.1016/j.amjms.2026.08.023","url":null,"abstract":"<p><p>Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) is a key immune checkpoint in Gastrointestinal system cancers (GSCs), inhibiting T-cell activation by outcompeting CD28 for B7-1/B7-2 binding on antigen-presenting cells, thereby promoting immune evasion. Its overexpression correlates with advanced stage, poor survival, and worse prognosis in gastric, colorectal, esophageal, and pancreatic cancers. CTLA-4 blockade with Ipilimumab or Tremelimumab shows promise, especially combined with PD-1/PD-L1 inhibitors, yielding enhanced antitumor immunity in microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) tumors with high immune infiltration. However, efficacy is limited by tumor heterogeneity and an immunosuppressive microenvironment enriched in CTLA-4⁺ regulatory T cells (Tregs). Inconsistent clinical responses underscore the need for predictive biomarkers, optimized combinations, and mechanistic insights into resistance. This review explores CTLA-4's role in GSCs, highlighting microenvironment-focused strategies to improve precision and therapeutic outcomes.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835741","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":"Comparative effectiveness and outcomes of direct oral anticoagulants vs. Vitamin K antagonists (VKA) in atrial arrhythmias patients with isolated lupus anticoagulant without antiphospholipid syndrome: a real-world cohort analysis.","authors":"Omar Obeidat, Laith Alhuneafat, Mohamed F Ismail, Stephanie Elbanna, Ahmad Al-Abdouh, Nada Alrifai, Deaa Abu Jazar, Yasmin Hamdan, Mohammed Alsadawi, Wissam Khalife, Mukaila Raji, Aiham Albaeni","doi":"10.1016/j.amjms.2026.08.019","DOIUrl":"10.1016/j.amjms.2026.08.019","url":null,"abstract":"<p><strong>Background: </strong>Direct oral anticoagulants (DOACs) are preferred over VKA for stroke prevention in atrial fibrillation/flutter (AF), but concerns exist regarding their use in antiphospholipid syndrome (APS). The safety and effectiveness of DOACs in AF patients with isolated lupus anticoagulant (LA) who do not meet APS criteria remain uncertain.</p><p><strong>Methods: </strong>Using the TriNetX global research network, we conducted a new-user, active-comparator cohort study of adults with AF/flutter (ICD-10 I48, on or after 2010) and laboratory-documented LA positivity (ICD-10 D68.62 or confirmatory ratio-based dRVVT/lupus-sensitive aPTT assays) established on or before anticoagulant initiation, excluding coded APS (D68.61) and documented positive anticardiolipin or anti-β2-glycoprotein I antibodies. The index date was the first qualifying DOAC or VKA prescription after AF diagnosis. Propensity score matching (1:1) balanced >100 covariates including prior stroke/TIA, prior bleeding, prior venous thromboembolism, renal function, and comorbidities. Co-primary outcomes were incident ischemic stroke and incident bleeding at 5 years, analyzed with Kaplan-Meier methods and Cox proportional hazards models.</p><p><strong>Results: </strong>After matching, 1152 patients were included (576 per group; mean follow-up ≈2.6 years). Incident ischemic stroke was similar between DOAC and VKA users (5.8% vs. 6.0%; HR 0.93, 95% CI 0.54-1.60; p = 0.80). The incident bleeding composite was directionally lower with DOACs without reaching significance (18.0% vs. 22.6%; HR 0.79, 95% CI 0.57-1.10; p = 0.17), as were severe intracranial bleeding (2.0% vs. 3.3%; HR 0.61, 95% CI 0.29-1.29) and the intracranial/GI hemorrhage composite (9.1% vs. 12.1%; HR 0.75, 95% CI 0.51-1.12). In a pre-specified full-cohort analysis retaining prior events, the bleeding advantage reached nominal significance (26.6% vs. 33.0%; HR 0.77, 95% CI 0.62-0.95). All-cause mortality did not differ (21.2% vs. 22.0%; HR 0.96, 95% CI 0.75-1.23; p = 0.73), and there were no significant differences in myocardial infarction, venous thromboembolism, or composite arterial events. An apixaban-specific analysis was consistent.</p><p><strong>Conclusions: </strong>In this new-user cohort of AF patients with isolated lupus anticoagulant, DOAC therapy was not associated with higher rates of ischemic stroke, arterial events, venous thromboembolism, or mortality compared with VKA, and bleeding outcomes were directionally lower with DOACs without reaching statistical significance. These hypothesis-generating findings suggest DOACs may be a reasonable option in this population, pending confirmation in prospective studies.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835856","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":"Response to the letter to the editor: comment on effectiveness and economic impact of medical and rehabilitation interventions in long COVID care.","authors":"Azita Zahiriharsini, Chester Ho, Kiran Pohar Manhas","doi":"10.1016/j.amjms.2026.08.014","DOIUrl":"10.1016/j.amjms.2026.08.014","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835890","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":"Predicting 28‑day mortality in critically ill patients: A combined model using APACHE II, lactate clearance, and Pcv-aCO₂.","authors":"Jing Li, Yufeng Chen, Baixue Yao, Yinyin Qiu","doi":"10.1016/j.amjms.2026.08.021","DOIUrl":"10.1016/j.amjms.2026.08.021","url":null,"abstract":"<p><strong>Background: </strong>Early identification of prognostic factors in critically ill patients is essential for optimizing ICU management. Although the APACHE II score, lactate clearance rate (LCR), and central venous-to-arterial carbon dioxide partial pressure difference (Pcv-aCO₂) are each associated with outcomes, their combined predictive value remains unclear. This study evaluated their individual and combined performance in predicting 28-day mortality.</p><p><strong>Methods: </strong>We retrospectively analyzed ICU patients admitted to Shaoxing Second Hospital from January 2021 to December 2023. Among 1188 screened patients, 634 were included. Clinical data, APACHE II score, initial Pcv-aCO₂, and 24-hour LCR were collected. Patients were classified as survivors or non-survivors at 28 days. Logistic regression identified independent predictors, and receiver operating characteristic curves assessed predictive performance. The predictive performance of individual indicators and their combined models was evaluated using the area under the curve (AUC), sensitivity, and specificity.</p><p><strong>Results: </strong>The 28-day mortality rate was 26.8%. Independent predictors included APACHE II score (OR=1.069), 24 h LCR (OR=0.306), Pcv-aCO₂ (OR=1.096), vasoactive drug use (OR=2.201), coagulation dysfunction (OR=1.781), and multiple organ dysfunction (OR=1.906) (all p< 0.05). Among single indicators, 24 h LCR showed the highest accuracy (AUC=0.909), followed by APACHE II score (AUC= 0.753) and Pcv-aCO₂ (AUC=0.739). The combination of 24 h LCR and APACHE II score achieved an AUC of 0.963, while adding Pcv-aCO₂ did not further increase the AUC but improved sensitivity and specificity.</p><p><strong>Conclusions: </strong>APACHE II score, 24 h LCR, and Pcv-aCO₂ are independent predictors of short-term mortality. Combined assessment improves prognostic accuracy, supporting integrated evaluation for risk stratification in critically ill patients.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820694","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":"Temporal and lineage-specific association between fibromyalgia and hematologic malignancies.","authors":"Eli Magen, Suhail Aamar, Israel Magen, Eugene Merzon, Ilan Green, Avivit Golan-Cohen, Shlomo Vinker, Ariel Israel","doi":"10.1016/j.amjms.2026.08.020","DOIUrl":"10.1016/j.amjms.2026.08.020","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820754","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":"Acidemia, lactate, and anemia are associated with clinically meaningful SpO₂-SaO₂ discordance in critically Ill adults.","authors":"Mina Ghbrial, Sheraz Khan, Saqib Baig","doi":"10.1016/j.amjms.2026.08.022","DOIUrl":"10.1016/j.amjms.2026.08.022","url":null,"abstract":"<p><strong>Background: </strong>Pulse oximetry is central to ICU care, yet clinically meaningful SpO₂-SaO₂ discordance is common and may reflect both racial/ethnic disparities and physiologic derangements. The independent contributions of acidemia, hyperlactatemia, and anemia to discordance have not been comprehensively evaluated in a large, diverse ICU cohort.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the Blood-gas and Oximetry Linked Dataset (BOLD). We analyzed patient-level paired SpO₂ and SaO₂ measurements within 5 min, limiting to one pair per hospitalization. After exclusions and complete-case requirements for hemoglobin, pH, lactate, race/ethnicity, and prespecified covariates including SOFA (past 24 h), MAP, and temperature, the primary analytic cohort included 10,094 adults. Outcomes were signed discrepancy (ΔSat = SpO₂ - SaO₂), clinically significant discordance (|ΔSat| ≥4%), and directional misclassification (underestimation ≤-4; overestimation ≥+4). Multivariable OLS, logistic, and multinomial regression were used; pH × lactate interaction was tested using mean-centered terms.</p><p><strong>Results: </strong>Mean ΔSat was 0.93±3.74%, and 18.5% met |ΔSat| ≥4%. Lower pH, higher lactate, and lower hemoglobin were independently associated with discordance. Black race and Hispanic ethnicity were associated with greater overestimation versus White patients after adjustment. A significant pH × lactate interaction suggested attenuation of the lactate-ΔSat association at lower pH. Findings were consistent in a larger sensitivity cohort (N = 18,804).</p><p><strong>Conclusions: </strong>In critically ill adults, acidemia, hyperlactatemia, and anemia are associated with clinically meaningful SpO₂-SaO₂ discordance, alongside persistent racial/ethnic differences in overestimation. Clinicians should interpret SpO₂ cautiously in metabolically stressed and anemic patients and consider confirmatory testing when clinical concern exists.</p>","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820724","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":"Effectiveness and economic impact of medical and rehabilitation interventions in long COVID care.","authors":"Dua Jabbar, Summaya Maqsood, Rakesh Kumar, Aajay Kumar, Fun Ghansham","doi":"10.1016/j.amjms.2026.08.015","DOIUrl":"10.1016/j.amjms.2026.08.015","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803977","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 gain associated with cardiovascular therapy: Four phenotypes, different clinical meanings.","authors":"Yalcin Velibey, Erkan Kahraman, Edibe Betul Borklu, Gokturk Ipek, Tolga Sinan Guvenc, Osman Bolca","doi":"10.1016/j.amjms.2026.08.017","DOIUrl":"10.1016/j.amjms.2026.08.017","url":null,"abstract":"","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803998","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}