American Journal of Medicine最新文献

英文中文

Febuxostat Leads to Better Cardiovascular Outcomes Compared to Allopurinol in Patients With Advanced Chronic Kidney Disease: A Population-Based Cohort Study 与别嘌醇相比，非布司他能为晚期慢性肾病患者带来更好的心血管治疗效果：基于人群的队列研究

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.09.018

Ming-Hsien Tsai MD, PhD , Yun-Yi Chen PhD , Hung-Hsiang Liou MD , Jing-Tong Wang AN , Yu-Wei Fang MD, PhD

Objective

Hyperuricemia is a risk factor for cardiovascular disease complications in patients with chronic kidney disease. The impact of febuxostat on cardiovascular disease in advanced chronic kidney disease remains unclear. This study aimed to explore the cardiovascular benefits of xanthine oxidase inhibitors, particularly febuxostat and allopurinol, in patients with advanced chronic kidney disease.

Methods

A retrospective population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database (NHIRD) (2012–2020). The TriNetX dataset served as an external validation dataset. The study involved 13,187 patients with advanced chronic kidney disease treated with febuxostat or allopurinol. After propensity score matching, a balanced cohort of 976 patients (488 in each arm) was created. Hazard ratios (HRs) were calculated for all-cause mortality and hospitalizations, utilizing the competing risk regression model.

Results

Febuxostat was associated with lower all-cause mortality (HR, 0.79; 95% confidence interval [CI], 0.64-0.98) and fewer hospitalizations (HR, 0.53; 95% CI, 0.44-0.63) than allopurinol. After adjustments, febuxostat also reduced hospitalizations for heart failure (HR, 0.59; 95% CI, 0.43-0.80) and infection (HR, 0.65; 95% CI, 0.52-0.82). This cardiovascular benefit of febuxostat was consistently observed in the TriNetX dataset. Moreover, subgroup analysis revealed that febuxostat was better in reducing death and heart failure events than allopurinol across most of the subgroups.

Conclusions

Febuxostat may confer cardioprotective effects in patients with advanced chronic kidney disease compared with allopurinol, thereby making it potentially useful in reducing cardiovascular risks in this high-risk population.

目的：高尿酸血症是慢性肾脏病患者并发心血管疾病的一个危险因素。非布索坦对晚期慢性肾脏病患者心血管疾病的影响仍不明确。本研究旨在探讨黄嘌呤氧化酶抑制剂（尤其是非布司他和别嘌醇）对晚期慢性肾病患者心血管疾病的益处：方法：利用台湾国民健康保险研究数据库（NHIRD）（2006-2017年）的数据开展了一项基于人群的回顾性队列研究。TriNetX 数据集作为外部验证数据集。研究涉及13187名接受非布索坦或别嘌醇治疗的晚期慢性肾病患者。经过倾向评分匹配后，建立了一个由 976 名患者（每组 488 人）组成的平衡队列。利用竞争风险回归模型计算了全因死亡率和住院率的危险比（HRs）：与别嘌醇相比，非布司他可降低全因死亡率（HR，0.79；95% 置信区间 [CI]，0.64-0.98），减少住院次数（HR，0.53；95% 置信区间，0.44-0.63）。经过调整后，非布司他还减少了心力衰竭（HR，0.59；95% CI，0.43-0.80）和感染（HR，0.65；95% CI，0.52-0.82）的住院次数。非布索坦在心血管方面的这种益处在TriNetX数据集中得到了一致观察。此外，亚组分析显示，在大多数亚组中，非布司他在减少死亡和心衰事件方面优于别嘌醇：与别嘌醇相比，非布索坦可为晚期慢性肾脏病患者提供心脏保护作用，因此可能有助于降低这一高风险人群的心血管风险。

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引用次数: 0

Vitamin K Antagonist Anticoagulation in Antiphospholipid Syndrome: Time in Therapeutic Range and Clinical Outcomes 抗磷脂综合征中的维生素 K 拮抗剂抗凝：治疗范围内的时间和临床结果。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.09.019

Keren Meir MD , Stanley Niznik MD , Orly Avnery MD , Adi Zoref-Lorenz MD , Nancy Agmon-Levin MD , Martin H. Ellis MD

Background

Thrombosis in antiphospholipid syndrome is still frequently treated with vitamin K antagonists, with a target international normalized ratio of 2-3. Time in therapeutic range of international normalized ratio of ≥ 70% is considered optimal. Time in therapeutic range among antiphospholipid syndrome patients is not well documented and the clinical consequences of poor international normalized ratio control are uncertain. This study aimed to determine the proportion of vitamin K antagonist-treated antiphospholipid syndrome patients achieving time in therapeutic range ≥ 70%, to define the features associated with poor control and to determine its association with thrombotic and bleeding events.

Methods

This medical records review included antiphospholipid syndrome patients treated with vitamin K antagonists, between 2012-2023. The proportion of patients achieving a time in therapeutic range ≥ 70% was determined, and thrombotic and bleeding events were compared between patients with time in therapeutic range ≥ 70% vs < 70%.

Results

Sixty seven antiphospholipid syndrome patients were studied. It was observed that 29.9% achieved time in therapeutic range ≥ 70% and 9.1% of patients with 3 or more comorbidities achieved time in therapeutic range values ≥ 70% compared with 40% of patients with less than 3 comorbidities. Fewer recurrent arterial and overall thrombotic events occurred with time in therapeutic range ≥ 70%.

Conclusions

A minority of antiphospholipid syndrome patients treated with vitamin K antagonists achieve optimal anticoagulation and are at risk for recurrent thrombotic events, particularly arterial. Presence of multiple comorbidities is associated with poor international normalized ratio control. Careful monitoring of this patient population is warranted.

背景：抗磷脂综合征中的血栓形成仍经常使用维生素 K 拮抗剂治疗，目标国际正常化比率为 2-3。国际正常化比率在治疗范围内的时间≥ 70% 被认为是最佳的。目的：确定接受维生素K拮抗剂治疗的抗磷脂综合征患者中达到治疗范围内时间≥70%的比例，明确与控制不佳相关的特征，并确定其与血栓和出血事件的关系：病历回顾包括2012-2023年间接受维生素K拮抗剂治疗的抗磷脂综合征患者。结果：67 名抗磷脂综合征患者的血栓和出血事件发生率达到了 70%：研究了67名抗磷脂综合征患者。29.9%的患者治疗时间≥70%。9.1%患有3种或3种以上并发症的患者达到治疗范围时间值≥70%，而患有3种以下并发症的患者为40%。治疗范围内时间≥70%的患者发生复发性动脉和整体血栓事件的比例较低：少数接受维生素 K 拮抗剂治疗的抗磷脂综合征患者能达到最佳抗凝效果，但有复发血栓事件的风险，尤其是动脉血栓事件。存在多种并发症与国际标准化比率控制不佳有关。有必要对这类患者进行仔细监测。

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引用次数: 0

A Persistent Abdominal Pain With High Blood Pressure 持续性腹痛伴有高血压。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.10.005

Julien Graessel , Philippe Kauffmann MD , Pierrick Le Borgne MD, MSc

引用次数: 0

Severe Left Ventricular Dilation in an Active Duty Athlete With Bicuspid Aortic Valve and Aortic Regurgitation 一名主动脉瓣二尖瓣和主动脉瓣反流的现役运动员左心室严重扩张。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.10.003

Robert L. Fenequito MD, FACP , Travis E. Harrell MD, FACC, FACP , Gilbert E. Boswell MD, FACR , Matthew C. Russell MD, FACC, FACP

引用次数: 0

Sociodemographic Disparities in Coronary Artery Calcium Screening 冠状动脉钙化筛查中的社会人口差异。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.10.006

Andrew Faturos MD, MPH , Melinda Wong BS , Ahmadreza Ghasemiesfe MD , Ezra A. Amsterdam MD , Surabhi Atreja MD

Objectives

This study aimed to compare the demographic features and socioeconomic status of patients who underwent coronary artery calcium screening to that of their local population.

Background

Coronary artery calcium scores provide important evidence of subclinical atherosclerosis. However, insurance often does not cover coronary artery calcium testing, which could exclude people of lower socioeconomic status.

Methods

Demographic and occupational data were obtained for all patients referred for coronary artery calcium in a metropolitan area between October 2010 and August 2023. Household income and population reference information were taken from US Census Data and matched to zip code and regional metropolitan area.

Results

Coronary artery calcium tests were performed on 627 patients with a median age of 63 years and equal gender representation (52% female, 48% male). Patients were predominately White (77%) and English-speaking (98%), which is incongruent with local demographic data (P < .001). Healthcare workers were the largest workforce (22%), followed by people involved in education (12%), which is higher than the local healthcare workforce of 10% (P < .001). Those with graduate/professional degrees accounted for 32% of patients, significantly more than the local population (P < .001). The average median annual income ($94,116) of patients who underwent CAC testing was greater than that of the metropolitan median income of $81,264 (P < .001).

Conclusion

The disproportionate distribution of coronary artery calcium screening favoring educated, affluent, White English speakers indicates that higher-income and healthcare personnel are more likely to receive testing. Disparities in coronary artery calcium testing, especially in minorities and non-English speaking individuals, should be further explored.

研究目的本研究旨在将接受冠状动脉钙筛查的患者的人口特征和社会经济状况与当地人口的人口特征和社会经济状况进行比较：背景：冠状动脉钙化评分是亚临床动脉粥样硬化的重要证据。背景：冠状动脉钙化评分是亚临床动脉粥样硬化的重要证据，但保险通常不包括冠状动脉钙化检测，这可能会将社会经济地位较低的人群排除在外：方法：我们获取了 2010 年 10 月至 2023 年 8 月期间某大都市地区所有转诊的冠状动脉钙化患者的人口和职业数据。家庭收入和人口参考信息来自美国人口普查数据，并与邮政编码和地区都市区相匹配：对 627 名患者进行了冠状动脉钙化检测，中位年龄为 63 岁，男女比例相当（女性占 52%，男性占 48%）。患者主要为白人（77%）和讲英语者（98%），这与当地的人口统计数据不符（p结论：冠状动脉钙化检查的分布比例失调是一个重要的原因：冠状动脉钙筛查偏向于受过教育、富裕、讲英语的白人，这种不成比例的分布表明，高收入人群和医护人员更有可能接受检查。应进一步探讨冠状动脉钙化检测中的差异，尤其是少数民族和非英语人士的差异。

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引用次数: 0

Clinical and Laboratory Characteristics of Fatigue-Dominant Long-COVID Subjects: A Cross-Sectional Study 以疲劳为主的长期 COVID 患者的临床和实验室特征：一项横断面研究

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.01.025

Jin-Seok Lee PhD , Yujin Choi MD , Jin-Yong Joung MD, PhD , Chang-Gue Son MD, PhD

Background

Long COVID is defined by persistent symptoms following COVID-19 infection. Approximately 71% of individuals with long COVID experience ongoing fatigue, postexertional malaise, and cognitive impairments, which share pathological similarities with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This similarity has prompted studies to explore the characteristics of long COVID to gain a better understanding of ME/CFS. To gain insights, we investigated the clinical and laboratory characteristics of individuals with fatigue-dominant long COVID.

Methods

We enrolled 100 subjects (36 males, 64 females) with long COVID who had a higher score than 60 in the modified Korean version of the Chalder Fatigue Scale (mKCFQ11) and higher than 5 in a fatigue-focused visual analogue scale. To investigate fatigue symptoms, the mKCFQ11, the Multidimensional Fatigue Inventory, a visual analogue scale for fatigue and brain fog, along with the Short-Form survey, were employed. We also measured 3 cytokines and cortisol levels for immunological and endocrinological indicators. As a cross-sectional observational study, the data were collected at a single point in time.

Results

The mean scores on the measurements showed severe fatigue, and these scores were significantly correlated, with no differences based on sex, the post-COVID period, or age. Among the laboratory tests, plasma cortisol levels had a significant negative correlation with fatigue scores and a positive correlation with living quality. The negative correlation between cortisol levels and mKCFQ11 scores appeared to be more specific to mental fatigue than physical, which conflicted with other measurements.

Conclusion

Our findings provide the first insights into the characteristics of fatigue in individuals with long COVID, particularly in terms of fatigue severity and cortisol levels. These results serve as valuable reference data for clinicians dealing with fatigue symptoms in long-COVID patients and for researchers exploring postviral fatigue symptoms, including ME/CFS, in the future.

背景：长COVID是指感染COVID-19后出现的持续症状。约 71% 的长期 COVID 患者会出现持续疲劳、劳累后乏力和认知障碍，其病理特征与肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）相似。这种相似性促使研究人员探索长COVID的特征，以便更好地理解ME/CFS。为了加深理解，我们调查了以疲劳为主的长COVID患者的临床和实验室特征：我们招募了 100 名患有长COVID的受试者（36 名男性，64 名女性），这些受试者的改良版韩国查尔德疲劳量表（mKCFQ11）得分高于 60 分，以疲劳为重点的视觉模拟量表（VAS）得分高于 5 分。为了调查疲劳症状，我们采用了 mKCFQ11、多维疲劳量表 (MFI-20)、疲劳和脑雾 VAS 以及短表调查 (SF-12)。我们还测量了三种细胞因子和皮质醇水平，以了解免疫学和内分泌学指标。作为一项横断面观察研究，数据是在一个时间点收集的：结果：测量结果的平均分显示出严重的疲劳感，而且这些分数与性别、COVID 后时期或年龄无显著相关性。在实验室检测中，血浆皮质醇水平与疲劳评分呈显著负相关，与生活质量呈正相关。皮质醇水平与 mKCFQ11 分数之间的负相关似乎更多的是针对精神疲劳，而不是身体疲劳，这与其他测量结果相矛盾：我们的研究结果首次揭示了长期 COVID 患者的疲劳特征，尤其是疲劳严重程度和皮质醇水平。这些结果为临床医生处理长期 COVID 患者的疲劳症状提供了宝贵的参考数据，也为研究人员今后探索病毒后疲劳症状（包括 ME/CFS ）提供了宝贵的参考数据。

{"title":"Clinical and Laboratory Characteristics of Fatigue-Dominant Long-COVID Subjects: A Cross-Sectional Study","authors":"Jin-Seok Lee PhD , Yujin Choi MD , Jin-Yong Joung MD, PhD , Chang-Gue Son MD, PhD","doi":"10.1016/j.amjmed.2024.01.025","DOIUrl":"10.1016/j.amjmed.2024.01.025","url":null,"abstract":"<div><h3>Background</h3><div><span>Long COVID is defined by persistent symptoms following COVID-19 infection. Approximately 71% of individuals with long COVID experience ongoing fatigue, postexertional malaise, and </span>cognitive impairments, which share pathological similarities with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This similarity has prompted studies to explore the characteristics of long COVID to gain a better understanding of ME/CFS. To gain insights, we investigated the clinical and laboratory characteristics of individuals with fatigue-dominant long COVID.</div></div><div><h3>Methods</h3><div><span>We enrolled 100 subjects (36 males, 64 females) with long COVID who had a higher score than 60 in the modified Korean version of the Chalder Fatigue Scale (mKCFQ11) and higher than 5 in a fatigue-focused visual analogue scale. To investigate fatigue symptoms, the mKCFQ11, the Multidimensional Fatigue Inventory, a visual analogue scale for fatigue and brain fog, along with the Short-Form survey, were employed. We also measured 3 cytokines and </span>cortisol levels for immunological and endocrinological indicators. As a cross-sectional observational study, the data were collected at a single point in time.</div></div><div><h3>Results</h3><div>The mean scores on the measurements showed severe fatigue, and these scores were significantly correlated, with no differences based on sex, the post-COVID period, or age. Among the laboratory tests<span>, plasma cortisol<span><span> levels had a significant negative correlation with fatigue scores and a positive correlation with living quality. The negative correlation between cortisol levels and mKCFQ11 scores appeared to be more specific to </span>mental fatigue than physical, which conflicted with other measurements.</span></span></div></div><div><h3>Conclusion</h3><div>Our findings provide the first insights into the characteristics of fatigue in individuals with long COVID, particularly in terms of fatigue severity and cortisol levels. These results serve as valuable reference data for clinicians dealing with fatigue symptoms in long-COVID patients and for researchers exploring postviral fatigue symptoms, including ME/CFS, in the future.</div></div>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"138 2","pages":"Pages 346-353.e1"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Case-Based Approach to the Management of Patients with Chronic Coronary Disease: Updates from the 2023 AHA/ACC Guidelines 基于病例的慢性冠心病患者管理方法：2023 AHA/ACC 指南的更新。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.09.013

Yoo Jin Kim MD , Jasmine Malhi MD , Jeff Trost MD , Thorsten Leucker MD, PhD , Salim S. Virani MD , L. Kristin Newby MD , Roger S. Blumenthal MD , Essa Hariri MD, MSc

The 2023 American Heart Association (AHA)/American College of Cardiology (ACC) Multisociety Guideline for the Management of Patients with Chronic Coronary Disease presents important updates to the care of patients with chronic coronary disease. The recommendations of these guidelines inform the care for patients with 1) asymptomatic coronary artery disease, 2) stable angina or equivalent symptoms (e.g., dyspnea upon exertion), 3) symptomatic nonobstructive coronary disease including coronary microvascular dysfunction and vasospasm, and 4) left ventricular (LV) systolic dysfunction with known coronary artery disease. In this review, we aim to demonstrate key recommendations in the 2023 guideline using the following four hypothetical cases.

2023 年美国心脏协会 (AHA) / 美国心脏病学会 (ACC) 多协会《慢性冠心病患者管理指南》对慢性冠心病患者的护理进行了重要更新 (1)。这些指南的建议为以下患者的治疗提供了参考：(1) 无症状冠状动脉疾病；(2) 稳定型心绞痛或同等症状（如劳累后呼吸困难）；(3) 无症状非阻塞性冠状动脉疾病，包括冠状动脉微血管功能障碍和血管痉挛；(4) 左心室收缩功能障碍伴已知冠状动脉疾病。在本综述中，我们旨在通过以下四个假设病例来展示 2023 年指南中的主要建议。

引用次数: 0

Unraveling Tuberculosis: An Atypical Tuberculous Presentation 揭开结核病的神秘面纱：非典型肺结核表现。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.10.014

Genevieve M.Y. Tan MBBS, MRCP (UK), MMed (Int Med), PhD, FAMS , Ying Na Ho MBBS, MRCP , Glenn K.W. Yong MBBS, MRCP(UK), MMed (Int Med)

引用次数: 0

In Response to a 20-Year Multicenter Study on the Evolution of Internal Medicine Residents

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.09.020

Emily Mullen MD, FACP, Carolyn Guilloud MD, Julie Machen MD

引用次数: 0

How to Receive a Compliment and a Criticism in Medicine 如何接受医学界的赞美和批评。

IF 2.5 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amjmed.2024.08.035

Daniel M. Gelfman MD, FACC, FACP

引用次数: 0

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