The American journal of the medical sciences最新文献_第4页

Distinguishing autoimmune recurrence from rejection in simultaneous pancreas-kidney transplantation recipients: a case-based short review. 同时胰肾移植受者自身免疫复发与排斥反应的区别：一项基于病例的简短回顾

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-22 DOI: 10.1016/j.amjms.2026.08.018

Samuele Petridis, Ayoola Olayiwola, Francesco Vendrame, David Baidal, George Burke, Alberto Pugliese, Ron T Varghese

{"title":"Distinguishing autoimmune recurrence from rejection in simultaneous pancreas-kidney transplantation recipients: a case-based short review.","authors":"Samuele Petridis, Ayoola Olayiwola, Francesco Vendrame, David Baidal, George Burke, Alberto Pugliese, Ron T Varghese","doi":"10.1016/j.amjms.2026.08.018","DOIUrl":"10.1016/j.amjms.2026.08.018","url":null,"abstract":"Simultaneous pancreas-kidney (SPK) transplantation provides durable glycemic control and survival benefit for selected patients with Type 1 diabetes and end-stage renal disease. Late-onset hyperglycemia after SPK is diagnostically challenging because pancreas graft dysfunction may reflect acute or chronic rejection, calcineurin inhibitor toxicity, vascular complications, post-transplant diabetes, or recurrent autoimmune type 1 diabetes (T1DR). Autoimmune recurrence occurs in a minority of recipients and is characterized by insulitis with selective beta-cell loss, often preceded by islet autoantibody conversion and progressive C-peptide decline. Distinguishing recurrence from rejection is clinically important because rejection may respond to intensified anti-rejection therapy, whereas established T1DR has no proven disease-modifying treatment. This case-based short review synthesizes current evidence on epidemiology, timing, maintenance immunosuppression, immunopathogenesis, genetic susceptibility, biomarkers, imaging, Banff-based histopathology, differential diagnosis, and management of recurrent autoimmune diabetes after SPK transplantation. A structured diagnostic approach integrating clinical timing, serology, metabolic testing, imaging, donor-specific antibody assessment, and pancreas biopsy with immunohistochemistry can help clinicians avoid both delayed recognition of recurrence and unnecessary escalation of immunosuppression.","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":"148803979","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

Mortality from selected cardiovascular-kidney-metabolic conditions among adults aged 65 years or older, 1999-2023. 1999-2023年65岁以上成人心血管-肾脏-代谢疾病的死亡率

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-22 DOI: 10.1016/j.amjms.2026.08.016

Ru Jia, Yan Ma, Angela Vinturache, Guodong Ding

引用次数: 0

Glycolysis, inflammation, and mitochondrial dysfunction: new perspectives on the pathogenesis of hypertension. 糖酵解、炎症和线粒体功能障碍：高血压发病机制的新视角。

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-22 DOI: 10.1016/j.amjms.2026.08.013

Runmin Cao, Yurun Zhang, Ling Cao, Honghe Jiang

{"title":"Glycolysis, inflammation, and mitochondrial dysfunction: new perspectives on the pathogenesis of hypertension.","authors":"Runmin Cao, Yurun Zhang, Ling Cao, Honghe Jiang","doi":"10.1016/j.amjms.2026.08.013","DOIUrl":"10.1016/j.amjms.2026.08.013","url":null,"abstract":"Background: Recent studies show enhanced glycolysis is linked to chronic diseases, but its relationship with hypertension is unclear. This study explores glycolysis-hypertension links and Pan-Immune Inflammation Value (PIV) and mitochondrial dysfunction chain mediation.Methods: Data were derived from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, with 8419 participants included after excluding missing data. Weighted multivariate logistic regression was employed to analyze the independent association between glycolysis and hypertension. Restricted cubic spline curves and threshold effect analysis were used to evaluate the nonlinear relationship between LDH and hypertension. Chain mediation analysis assessed the mediating effects of PIV and mitochondrial dysfunction. Machine learning models predicted hypertension, with three interpretable methods (permutation feature importance, Partial Dependence Plots, and SHAP) embedded in the best-performing model.Results: After adjusting for confounding factors, both continuous and quartile-based LDH levels showed significant positive correlations with hypertension. A U-shaped association was found, with an inflection point (ln-LDH) of 4.533. Further mediation analysis showed that PIV and mitochondrial dysfunction partially mediated the association between LDH and hypertension, with the indirect effects through PIV alone and mitochondrial dysfunction alone accounting for 2.91% and 6.09% of the total effect, respectively. In addition, the serial indirect effect through PIV and subsequently mitochondrial dysfunction accounted for 0.20% of the total effect. The XGB model had the best predictive performance for hypertension, with LDH, PIV, and MMA being important predictive variables.Conclusions: This study emphasizes the important roles of inflammation and mitochondrial dysfunction in the relationship between glycolysis and hypertension.","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":"148804033","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

Post-pandemic divergence in econsult utilization across medical specialties. 大流行后各医学专业会诊利用的差异。

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-21 DOI: 10.1016/j.amjms.2026.08.012

Vincent Le, Joy Xu, Josie Pearce, Justin Ko, Gordon H Bae

引用次数: 0

Benefit-risk of voxelotor, crizanlizumab, and l-glutamine in sickle cell disease: A systematic review. Voxelotor、Crizanlizumab和l -谷氨酰胺治疗镰状细胞病的获益-风险：一项系统综述

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-21 DOI: 10.1016/j.amjms.2026.08.010

Jingang Wang, Hongfang Lu

{"title":"Benefit-risk of voxelotor, crizanlizumab, and l-glutamine in sickle cell disease: A systematic review.","authors":"Jingang Wang, Hongfang Lu","doi":"10.1016/j.amjms.2026.08.010","DOIUrl":"10.1016/j.amjms.2026.08.010","url":null,"abstract":"Background: Newer pharmacologic therapies for sickle cell disease target different clinical domains, complicating class-level comparison. Postapproval developments, including voxelotor withdrawal and regulatory reassessment of crizanlizumab, warrant a therapy-specific reassessment of benefit and risk.Methods: We searched PubMed/MEDLINE, Scopus, Web of Science Core Collection, and CINAHL through April 4, 2026, for clinical evidence on l-glutamine, crizanlizumab, and voxelotor. Two reviewers independently screened records, assessed full texts, extracted data, and appraised methodological concerns. Core randomized evidence was distinguished from early randomized, linked follow-up, supportive secondary, and contextual evidence. Pooling was considered only for independent studies with clinically comparable outcomes and compatible follow-up.Results: Of 742 records identified, 398 remained after deduplication, 52 full-text reports were assessed, and eight studies contributed to the structured synthesis. l-glutamine reduced vaso-occlusive crisis burden in the pivotal trial (rate ratio, 0.75; 95% confidence interval, 0.62-0.90). Crizanlizumab prolonged time to first vaso-occlusive crisis in SUSTAIN (hazard ratio, 0.50; 95% confidence interval, 0.33-0.75), but evidence remained dependent on one core randomized trial. Voxelotor primarily improved hemoglobin response (risk ratio, 7.84; 95% confidence interval, 3.52-17.4). No primary pooled meta-analysis was performed because comparable independent evidence was sparse, follow-up differed, linked reports overlapped, and several safety outcomes were noninformative.Conclusions: The evidence supports therapy-specific benefit signals rather than a pooled class-level conclusion. Benefit-risk interpretation should distinguish vaso-occlusive morbidity from hemoglobin-centered outcomes and account for replication, durability, and safety completeness.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804002","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

Blood transfusion in patients with anemia and heart failure: Translating guidelines into practice. 贫血和心力衰竭患者输血：将指南转化为实践。

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-21 DOI: 10.1016/j.amjms.2026.08.011

Yalcin Velibey, Erkan Kahraman, Bilal Cakir, Gokturk Ipek, Tolga Sinan Guvenc, Osman Bolca

引用次数: 0

Association of body fluid distribution with bone mineral density and osteoporosis in men aged under 50: A cross-sectional study. 50岁以下男性体液分布与骨密度和骨质疏松症的关系：一项横断面研究

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-21 DOI: 10.1016/j.amjms.2026.08.009

Wanxin Su, Sizhe Xiao, Yanhui Li, Zhikun Yuan

{"title":"Association of body fluid distribution with bone mineral density and osteoporosis in men aged under 50: A cross-sectional study.","authors":"Wanxin Su, Sizhe Xiao, Yanhui Li, Zhikun Yuan","doi":"10.1016/j.amjms.2026.08.009","DOIUrl":"10.1016/j.amjms.2026.08.009","url":null,"abstract":"Background: This cross-Sectional study aimed to elucidate the relationship between body fluid distribution and bone mineral density (BMD) as well as the risk of osteoporosis in men aged under 50.Methods: The study included male participants aged under 50 from the National Health and Nutrition Examination Survey (NHANES). BMD was measured via dual-energy X-ray absorptiometry (DXA). Body fluid distribution was defined as extracellular fluid (ECF), intracellular fluid (ICF), and total body water (TBW) assessed by bioelectrical impedance analysis. Weighted logistic regression and weighted linear regression were adopted to unveil the associations of body fluid distribution with osteoporosis risk and BMD. Subgroup analyses were carried out. Restrictive cubic spline (RCS) models were leveraged to unravel potential non-linear relationships of body fluid distribution with osteoporosis risk and BMD.Results: 1815 participants (weighted samples: 46,823,836) were encompassed in our analysis. Among the participants, 10 cases of osteoporosis were identified (weighted samples: 319,031). The results showed significant correlations of increases in ECF, ICF, and TBW with a decrease in osteoporosis risk and an elevation in BMD. RCS analysis indicated an approximately linear relationship between body fluid components and both osteoporosis risk and BMD. Subgroup analysis revealed consistent trends between body fluid components, osteoporosis risk, and BMD across various subgroups.Conclusions: Increases in ECF, ICF, and TBW were significantly linked to a lowered osteoporosis risk and enhanced BMD. These findings may aid clinicians in the early identification and intervention of patients at risk for bone loss. However, due to the cross-sectional design, causality cannot be inferred, and prospective studies are warranted.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803986","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

Dissociation between airflow and lung volume responses following triple therapy device switching in asthma-COPD overlap. 哮喘-慢性阻塞性肺病重叠三联治疗设备切换后气流和肺容量反应的分离。

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-20 DOI: 10.1016/j.amjms.2026.08.007

Hideyasu Yamada, Taisuke Nakaizumi

引用次数: 0

Weekend warrior physical activity pattern in relation to sleep outcomes in United States adults. 美国成年人的周末运动模式与睡眠结果的关系

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-19 DOI: 10.1016/j.amjms.2026.08.008

Zilin Fan, Ziqi Fan, Haonan Wang, Huayi Zhou, Tianyang Wang, Shenyi Dong, Hui He

{"title":"Weekend warrior physical activity pattern in relation to sleep outcomes in United States adults.","authors":"Zilin Fan, Ziqi Fan, Haonan Wang, Huayi Zhou, Tianyang Wang, Shenyi Dong, Hui He","doi":"10.1016/j.amjms.2026.08.008","DOIUrl":"10.1016/j.amjms.2026.08.008","url":null,"abstract":"Background: This study aimed to evaluate associations between the Weekend Warrior (WW) physical-activity pattern and adverse sleep outcomes in adults.Methods: Data were from adults ≥20 years in four NHANES cycles (2007-2014). Based on self-reported leisure-time MVPA, participants were classified as inactive, insufficiently active, WW, or regularly active (RA). Primary analyses were conducted in the complete-case sample (n = 16,036), and missing covariates were addressed in a multiple-imputation sensitivity analysis (n = 22,495). Survey-weighted logistic regression estimated associations of patterns with short and long sleep, sleep problems, and sleep disorders. Restricted cubic splines evaluated non-linear relations between weekly MVPA and sleep outcomes.Results: Compared with inactivity, the WW pattern was associated with lower odds of self-reported sleep problems (OR = 0.73, 95% CI: 0.57-0.95), and also showed lower odds of sleep problems compared with RA (OR = 0.76, 95% CI: 0.60-0.97). The RA pattern was associated with lower odds of physician-diagnosed sleep disorders (OR = 0.72, 95% CI: 0.57-0.90) and short sleep (OR = 0.84, 95% CI: 0.77-0.91) compared with inactivity. Multiple-imputation sensitivity analyses yielded broadly consistent findings for sleep problems and sleep disorders. In the overall sample, weekly MVPA showed significant non-linear associations with sleep problems and sleep disorders, with lower estimated odds observed at moderate-to-high MVPA volumes.Conclusions: WW and RA patterns were both associated with more favorable sleep profiles than inactivity, suggesting that concentrated as well as regularly distributed activity may be compatible with better sleep health.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803995","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

"LAPAGE index in differentiating tuberculous pleurisy and malignant pleural effusion". “LAPAGE指数在鉴别结核性胸膜炎与恶性胸腔积液中的应用”。

IF 1.8

The American journal of the medical sciences Pub Date : 2026-08-16 DOI: 10.1016/j.amjms.2026.08.005

Ali Kirac, Banu Kahriman, Damla Azakli, Furkan Atasever, Huseyin Yunus Dogan, Celal Satici

{"title":"\"LAPAGE index in differentiating tuberculous pleurisy and malignant pleural effusion\".","authors":"Ali Kirac, Banu Kahriman, Damla Azakli, Furkan Atasever, Huseyin Yunus Dogan, Celal Satici","doi":"10.1016/j.amjms.2026.08.005","DOIUrl":"10.1016/j.amjms.2026.08.005","url":null,"abstract":"Introduction: Malignant pleural effusion and tuberculous pleurisy may both present with elevated levels, making their differential diagnosis challenging. Although an ADA level ≥ 40 U/L increases the likelihood of both conditions, additional biomarkers are needed for better discrimination. Therefore, we aimed to evaluate clinical and biochemical markers that could aid in differentiating these two conditions in patients with high ADA levels.Materials and methods: This retrospective cohort study included patients with pleural effusion and pleural fluid ADA levels ≥ 40 U/L who were evaluated between 2014 and 2024. The cancer ratio (serum LDH/pleural ADA) and the pleural LDH/ADA ratio, previously described in the literature, were calculated. Multivariable regression analysis was performed to identify independent predictors of malignant pleural effusion.Results: A total of 294 patients constituted the study cohort. In multivariable regression analysis, cancer ratio was not statistically significant in differentiating malignant pleural effusion from tuberculous pleurisy. In contrast, the pleural LDH/ADA ratio, pleural protein level and age were identified as independent predictors of malignant pleural effusion. The LAPAGE index, derived from these variables [(pleural LDH / ADA) × age / pleural protein], demonstrated superior diagnostic performance in predicting malignant pleural effusion compared with individual parameters.Conclusions: In patients with pleural effusion and ADA levels ≥ 40 U/L, neither the cancer ratio nor the pleural LDH/ADA ratio alone provided sufficient discriminatory power between malignant pleural effusion and tuberculous pleurisy. The LAPAGE index may serve as a useful adjunctive tool in the differential diagnosis of tuberculosis and malignancy in pleural effusions with high ADA levels.","PeriodicalId":94223,"journal":{"name":"The American journal of the medical sciences","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766596","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