American Journal of the Medical Sciences最新文献

英文中文

In-hospital isolated coronary artery bypass grafting outcomes in patients with psoriasis: a population-based National Inpatient Sample study from 2015–2021 银屑病患者院内孤立冠状动脉旁路移植术的预后：2015-2021年基于人群的全国住院患者样本研究

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.09.010

Renxi Li BS , SeungEun Lee BS , Deyanira J. Prastein MD , Stephen J. Huddleston MD, PhD

Background

Psoriasis is a chronic skin disease that shares common inflammatory pathways with atherosclerosis. Although psoriasis is known to increase risk of developing coronary artery disease, the impact of psoriasis on outcomes after coronary artery bypass grafting (CABG) remains less established. This study aimed to compare the in-hospital outcomes of isolated CABG between patients with and without psoriasis through a population-based analysis of a national database.

Methods

Patients underwent CABG were selected from National Inpatient Sample from Q4 2015–2021. Patients with age <18 years and concomitant procedures were excluded. A 1:2 propensity-score matching was used to match demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between psoriasis and non-psoriasis patients. In-hospital outcomes were assessed.

Results

There were 1,732 (0.95%) patients who underwent isolated CABG who had psoriasis. Patients with psoriasis were younger and more socioeconomically advantaged. After propensity-score matched to 3598 out of 191,175 non-psoriasis patients, patients with and without psoriasis had comparable in-hospital mortality rates (1.39% vs 1.03%, p = 0.27) and major adverse cardiovascular event (1.45% vs 1.86%, p = 0.31). Psoriasis patients had a slightly lower risk of venous thromboembolism (0.23% vs 0.67%, p = 0.04). All other in-hospital outcomes were comparable between psoriasis and non-psoriasis patients.

Conclusions

The representation of psoriasis patients in CABG was lower than their prevalence in the general population. After propensity-score matching, outcomes for patients with and without psoriasis were comparable. Thus, despite the elevated cardiovascular risks associated with psoriasis, CABG may be as safe and as effective for these patients.

背景：银屑病是一种慢性皮肤病，与动脉粥样硬化有共同的炎症途径。虽然银屑病已知会增加发生冠状动脉疾病的风险，但银屑病对冠状动脉旁路移植术（CABG）后预后的影响尚不明确。本研究旨在通过对国家数据库的基于人群的分析，比较有和无牛皮癣患者孤立性CABG的住院结果。方法：选取2015-2021年第四季度全国住院患者样本中接受CABG治疗的患者。结果：1732例（0.95%）行孤立性CABG的银屑病患者。银屑病患者年龄较小，社会经济条件较好。在191,175名非牛皮癣患者中，倾向评分与3,598名相匹配后，有和没有牛皮癣的患者的住院死亡率（1.39% vs 1.03%, p=0.27）和主要不良心血管事件（1.45% vs 1.86%, p=0.31）相当。银屑病患者发生静脉血栓栓塞的风险略低（0.23% vs 0.67%, p=0.04）。银屑病患者和非银屑病患者的所有其他住院结果具有可比性。结论：银屑病患者在CABG中的患病率低于其在普通人群中的患病率。在倾向评分匹配后，患有和不患有牛皮癣的患者的结果具有可比性。因此，尽管与牛皮癣相关的心血管风险升高，CABG对这些患者可能是安全有效的。

{"title":"In-hospital isolated coronary artery bypass grafting outcomes in patients with psoriasis: a population-based National Inpatient Sample study from 2015–2021","authors":"Renxi Li BS , SeungEun Lee BS , Deyanira J. Prastein MD , Stephen J. Huddleston MD, PhD","doi":"10.1016/j.amjms.2025.09.010","DOIUrl":"10.1016/j.amjms.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Psoriasis is a chronic skin disease that shares common inflammatory pathways with atherosclerosis. Although psoriasis is known to increase risk of developing coronary artery disease, the impact of psoriasis on outcomes after coronary artery bypass grafting (CABG) remains less established. This study aimed to compare the in-hospital outcomes of isolated CABG between patients with and without psoriasis through a population-based analysis of a national database.</div></div><div><h3>Methods</h3><div>Patients underwent CABG were selected from National Inpatient Sample from Q4 2015–2021. Patients with age <18 years and concomitant procedures were excluded. A 1:2 propensity-score matching was used to match demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between psoriasis and non-psoriasis patients. In-hospital outcomes were assessed.</div></div><div><h3>Results</h3><div>There were 1,732 (0.95%) patients who underwent isolated CABG who had psoriasis. Patients with psoriasis were younger and more socioeconomically advantaged. After propensity-score matched to 3598 out of 191,175 non-psoriasis patients, patients with and without psoriasis had comparable in-hospital mortality rates (1.39% vs 1.03%, <em>p</em> = 0.27) and major adverse cardiovascular event (1.45% vs 1.86%, <em>p</em> = 0.31). Psoriasis patients had a slightly lower risk of venous thromboembolism (0.23% vs 0.67%, <em>p</em> = 0.04). All other in-hospital outcomes were comparable between psoriasis and non-psoriasis patients.</div></div><div><h3>Conclusions</h3><div>The representation of psoriasis patients in CABG was lower than their prevalence in the general population. After propensity-score matching, outcomes for patients with and without psoriasis were comparable. Thus, despite the elevated cardiovascular risks associated with psoriasis, CABG may be as safe and as effective for these patients.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 1","pages":"Pages 30-35"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Questions regarding comparison of 24vs 72-hr octreotide infusion in acute esophageal variceal hemorrhage: A multi-center RCT 奥曲肽输注24小时vs 72小时治疗急性食管静脉曲张出血的问题：一项多中心随机对照试验

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.08.017

Ruyin Jia MD, PhD , Shuyi Chen MD, PhD , Guoshu Xu MD, PhD

引用次数: 0

Osteoimmunology: the little niche with the big impact 骨免疫学：小生态位，大影响。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.09.014

Shivmurat Yadav PhD , Jyoti Yadav MS , Derrick Jones , Mary Beth Humphrey MD, PhD

Osteoimmunology, which emerged in the early 2000s, was paradigm-shifting in its integration of immunology and skeletal research, recognizing the pivotal role of immunoreceptors on preosteoclasts, immune cells, and proinflammatory cytokines contributing to inflammatory bone remodeling. Numerous immunoreceptors and key signaling pathways were defined that regulate osteoclastogenesis. A dynamic interplay between lymphocytes and osteoclasts was found to be fundamental to maintaining bone homeostasis and contributing to pathological bone resorption in inflammatory arthritis or malignant metastasis. Osteoimmunology has expanded to include crosstalk between osteoclasts and osteoblasts, the role of bone marrow stromal cells in maintaining the hematopoietic stem cell niche, and the influence of the microbiome on lymphocytes that drive bone remodeling. Deciphering the intricate mechanisms that govern the immune system's regulation of bone remodeling remains a central objective in osteoimmunology, offering promising avenues for the development of targeted therapeutic strategies aimed at restoring skeletal equilibrium.

21世纪初出现的骨免疫学是免疫学和骨骼研究整合的范式转变，认识到免疫受体对破骨前细胞、免疫细胞和促炎细胞因子的关键作用，有助于炎症性骨重塑。确定了许多调节破骨细胞发生的免疫受体和关键信号通路。淋巴细胞和破骨细胞之间的动态相互作用被发现是维持骨稳态和促进炎性关节炎或恶性转移的病理性骨吸收的基础。骨免疫学已经扩展到包括破骨细胞和成骨细胞之间的串扰，骨髓基质细胞在维持造血干细胞生态位中的作用，以及微生物组对驱动骨重塑的淋巴细胞的影响。破译控制免疫系统调节骨重塑的复杂机制仍然是骨免疫学的中心目标，为旨在恢复骨骼平衡的靶向治疗策略的发展提供了有希望的途径。

{"title":"Osteoimmunology: the little niche with the big impact","authors":"Shivmurat Yadav PhD , Jyoti Yadav MS , Derrick Jones , Mary Beth Humphrey MD, PhD","doi":"10.1016/j.amjms.2025.09.014","DOIUrl":"10.1016/j.amjms.2025.09.014","url":null,"abstract":"<div><div>Osteoimmunology, which emerged in the early 2000s, was paradigm-shifting in its integration of immunology and skeletal research, recognizing the pivotal role of immunoreceptors on preosteoclasts, immune cells, and proinflammatory cytokines contributing to inflammatory bone remodeling. Numerous immunoreceptors and key signaling pathways were defined that regulate osteoclastogenesis. A dynamic interplay between lymphocytes and osteoclasts was found to be fundamental to maintaining bone homeostasis and contributing to pathological bone resorption in inflammatory arthritis or malignant metastasis. Osteoimmunology has expanded to include crosstalk between osteoclasts and osteoblasts, the role of bone marrow stromal cells in maintaining the hematopoietic stem cell niche, and the influence of the microbiome on lymphocytes that drive bone remodeling. Deciphering the intricate mechanisms that govern the immune system's regulation of bone remodeling remains a central objective in osteoimmunology, offering promising avenues for the development of targeted therapeutic strategies aimed at restoring skeletal equilibrium.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 1","pages":"Pages 87-96"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Mortality trends for bacterial septicaemia in the United States (1999–2024): Age, sex disparities and the impact of the COVID-19 pandemic 美国细菌性败血症死亡率趋势（1999-2024）：年龄、性别差异和COVID-19大流行的影响

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.09.012

Camilla Mattiuzzi MD , Giuseppe Lippi MD

Background

Sepsis remains a significant public health challenge, with persistent mortality rates despite advancements in diagnosis and treatment. This study examined mortality trends for bacterial septicaemia in the US between 1999–2024.

Methods

Mortality data were obtained from the National Center for Health Statistics, National Vital Statistics System, Provisional Mortality WONDER Online Database. Bacterial septicaemia-related deaths were identified using ICD-10 codes, and Poisson regression analysis was performed to assess trends across demographics.

Results

Mortality for bacterial septicaemia declined from 1999 to 2012, showing a modest increase until 2019. A sharp rise occurred during the COVID-19 pandemic (2020–2022), with total deaths for bacterial septicaemia increasing by 21.2 % compared to the pre-pandemic period (17.4 % in females and 23.9 % in males). Mortality rates in males were consistently higher than in females throughout the study period. Poisson regression analysis did not reveal statistically significant long-term cumulative or sex-specific trends. Age-stratified analysis showed a sustained decline in mortality over time among children under 15 years, whereas mortality increased in adults in all age groups between 25 and 74 years. Age-stratified analysis excluding the early pandemic years showed a relative decline in mortality for bacterial septicaemia in those aged <1 to 24 years, a relative increase in the 45–74-year age group, and a stable trend in other age categories.

Conclusions

Although cumulative mortality for bacterial septicaemia remained stable in the long term, rising deaths in middle-aged adults and pandemic-related increases highlight the need for reinforced prevention, timely diagnosis and accurate management strategies.

背景：脓毒症仍然是一个重大的公共卫生挑战，尽管诊断和治疗取得了进展，但其死亡率仍然居高不下。这项研究调查了1999年至2024年间美国细菌性败血症的死亡率趋势。方法：死亡率数据来源于国家卫生统计中心、国家生命统计系统、临时死亡率WONDER在线数据库。使用ICD-10代码确定细菌性败血症相关死亡，并进行泊松回归分析以评估人口统计学趋势。结果：细菌性败血症的死亡率从1999年到2012年下降，到2019年略有上升。在2019冠状病毒病大流行期间（2020-2022年）出现了急剧上升，与大流行前相比，细菌性败血症的总死亡人数增加了21.2%（女性为17.4%，男性为23.9%）。在整个研究期间，男性的死亡率始终高于女性。泊松回归分析没有显示统计上显著的长期累积或性别特异性趋势。年龄分层分析显示，随着时间的推移，15岁以下儿童的死亡率持续下降，而25-74岁之间所有年龄组的成年人死亡率均有所上升。结论：尽管细菌性败血症的累积死亡率长期保持稳定，但中年人死亡率的上升以及与大流行相关的死亡率增加，突出了加强预防、及时诊断和准确管理策略的必要性。

{"title":"Mortality trends for bacterial septicaemia in the United States (1999–2024): Age, sex disparities and the impact of the COVID-19 pandemic","authors":"Camilla Mattiuzzi MD , Giuseppe Lippi MD","doi":"10.1016/j.amjms.2025.09.012","DOIUrl":"10.1016/j.amjms.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis remains a significant public health challenge, with persistent mortality rates despite advancements in diagnosis and treatment. This study examined mortality trends for bacterial septicaemia in the US between 1999–2024.</div></div><div><h3>Methods</h3><div>Mortality data were obtained from the National Center for Health Statistics, National Vital Statistics System, Provisional Mortality WONDER Online Database. Bacterial septicaemia-related deaths were identified using ICD-10 codes, and Poisson regression analysis was performed to assess trends across demographics.</div></div><div><h3>Results</h3><div>Mortality for bacterial septicaemia declined from 1999 to 2012, showing a modest increase until 2019. A sharp rise occurred during the COVID-19 pandemic (2020–2022), with total deaths for bacterial septicaemia increasing by 21.2 % compared to the pre-pandemic period (17.4 % in females and 23.9 % in males). Mortality rates in males were consistently higher than in females throughout the study period. Poisson regression analysis did not reveal statistically significant long-term cumulative or sex-specific trends. Age-stratified analysis showed a sustained decline in mortality over time among children under 15 years, whereas mortality increased in adults in all age groups between 25 and 74 years. Age-stratified analysis excluding the early pandemic years showed a relative decline in mortality for bacterial septicaemia in those aged <1 to 24 years, a relative increase in the 45–74-year age group, and a stable trend in other age categories.</div></div><div><h3>Conclusions</h3><div>Although cumulative mortality for bacterial septicaemia remained stable in the long term, rising deaths in middle-aged adults and pandemic-related increases highlight the need for reinforced prevention, timely diagnosis and accurate management strategies.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 1","pages":"Pages 36-40"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 multiple sclerosis review for the primary care physician 初级保健医生多发性硬化症综述。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.09.007

William Meador MD , Helena Steen BS

Multiple Sclerosis (MS) is a complex neurological condition that requires an interprofessional approach to manage effectively. Primary care providers (PCPs) play a vital role in the management of MS as they represent the first line providers who can quickly and accurately recognize disease activity or worsening, assist patients with monitoring of disease burden and adequately address comorbidities that drive disease activity. This is especially true considering access constraints to specialists for patients residing in smaller communities. This article reviews how PCPs can recognize new disease activity versus pseudorelapse, can assist with medication monitoring, can support patients’ needs for imaging surveillance and can recognize the importance of managing comorbid illnesses. As many patients travel quite a distance to tertiary care centers for MS management, PCPs may be asked to assist with labwork monitoring or imaging support.

多发性硬化症（MS）是一种复杂的神经系统疾病，需要跨专业的方法来有效地管理。初级保健提供者（pcp）在MS的管理中起着至关重要的作用，因为他们代表了能够快速准确地识别疾病活动或恶化的第一线提供者，帮助患者监测疾病负担并充分解决驱动疾病活动的合并症。考虑到居住在较小社区的患者获得专家的限制，这一点尤其正确。本文综述了pcp如何识别新的疾病活动与假复发，如何协助药物监测，如何支持患者对成像监测的需求，以及如何认识到管理合并症的重要性。由于许多患者需要长途跋涉到三级医疗中心进行多发性硬化症治疗，pcp可能会被要求协助进行实验室监测或成像支持。

引用次数: 0

Fecal elastase measurement- beware; A cautionary tale 粪便弹性酶测量-小心；一个警世故事。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.10.015

C. Mel Wilcox MD, MSPH, Huy Tran MD

Background

Fecal elastase testing of stool is increasingly utilized for the diagnosis of exocrine pancreatic insufficiency (EPI). However, testing is being used in other settings such as evaluation of diarrhea where interpretation may be inaccurate resulting in unwarranted additional testing and prescription of pancreatic enzymes.

Methods

Over a 24-month period, we prospectively evaluated all patients referred to a pancreas clinic for evaluation of EPI using the fecal elastase (FE-1) measurement. A thorough history was obtained to determine the nature and duration of the complaints, risk factors for pancreatic disease, stool characteristics as well as laboratory and imaging evaluation.

Results

Over the study period, 54 patients (67 % female, median age 59 years (mean age 55 ± 16.5 years) were referred for “EPI” all of whom were evaluated for alteration in bowel habits. The median FE-1 concentration was 130 µg/g (range; 22 - >500 µg/g). Submitting a diarrheal stool for testing was prevalent. Established risk factors for pancreatic disease were present in 6. Because of the FE-1 results, additional cross-sectional abdominal imaging and/or endoscopic ultrasound were performed in 30 (56 %) and 15 (28 %) patients, respectively. The most common final diagnosis was irritable bowel syndrome (61 %); only 3 patients were considered to have chronic pancreatitis and true EPI.

Conclusions

Based upon our findings, most patients referred for EPI with an abnormal FE-1 measurement do not have malabsorption or EPI. Irritable bowel syndrome was the most common diagnosis. FE-1 testing is often misinterpreted, potentially overutilized and greater education is needed for its appropriate use and interpretation.

背景：粪便弹性酶测试越来越多地用于外分泌胰腺功能不全（EPI）的诊断。然而，检测也被用于其他场合，如评估腹泻，其解释可能不准确，导致不必要的额外检测和胰酶处方。方法：在24个月的时间里，我们前瞻性地评估了所有转到胰腺诊所使用粪便弹性酶（FE-1）测量评估EPI的患者。获得完整的病史，以确定投诉的性质和持续时间，胰腺疾病的危险因素，粪便特征以及实验室和影像学评估。结果：在研究期间，54例患者（67%为女性，中位年龄59岁（平均年龄55±16.5岁））被转介“EPI”，所有患者均被评估排便习惯的改变。中位FE-1浓度为130µg/g（范围22 ~ 500µg/g）。提交腹泻粪便进行检查的情况很普遍。6例患者存在已确定的胰腺疾病危险因素。由于FE-1的结果，分别有30例（56%）和15例（28%）患者进行了额外的腹部横切面成像和/或内镜超声检查。最常见的最终诊断是肠易激综合征（61%）；只有3例患者被认为是慢性胰腺炎和真正的EPI。结论：根据我们的发现，大多数因FE-1测量异常而接受EPI的患者并没有吸收不良或EPI。肠易激综合征是最常见的诊断。FE-1测试经常被误解，可能被过度利用，需要更多的教育来适当地使用和解释它。

{"title":"Fecal elastase measurement- beware; A cautionary tale","authors":"C. Mel Wilcox MD, MSPH, Huy Tran MD","doi":"10.1016/j.amjms.2025.10.015","DOIUrl":"10.1016/j.amjms.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Fecal elastase testing of stool is increasingly utilized for the diagnosis of exocrine pancreatic insufficiency (EPI). However, testing is being used in other settings such as evaluation of diarrhea where interpretation may be inaccurate resulting in unwarranted additional testing and prescription of pancreatic enzymes.</div></div><div><h3>Methods</h3><div>Over a 24-month period, we prospectively evaluated all patients referred to a pancreas clinic for evaluation of EPI using the fecal elastase (FE-1) measurement. A thorough history was obtained to determine the nature and duration of the complaints, risk factors for pancreatic disease, stool characteristics as well as laboratory and imaging evaluation.</div></div><div><h3>Results</h3><div>Over the study period, 54 patients (67 % female, median age 59 years (mean age 55 ± 16.5 years) were referred for “EPI” all of whom were evaluated for alteration in bowel habits. The median FE-1 concentration was 130 µg/g (range; 22 - >500 µg/g). Submitting a diarrheal stool for testing was prevalent. Established risk factors for pancreatic disease were present in 6. Because of the FE-1 results, additional cross-sectional abdominal imaging and/or endoscopic ultrasound were performed in 30 (56 %) and 15 (28 %) patients, respectively. The most common final diagnosis was irritable bowel syndrome (61 %); only 3 patients were considered to have chronic pancreatitis and true EPI.</div></div><div><h3>Conclusions</h3><div>Based upon our findings, most patients referred for EPI with an abnormal FE-1 measurement do not have malabsorption or EPI. Irritable bowel syndrome was the most common diagnosis. FE-1 testing is often misinterpreted, potentially overutilized and greater education is needed for its appropriate use and interpretation.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 1","pages":"Pages 71-75"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Advances in research on monogenic hereditary hypertension 单基因遗传性高血压的研究进展。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.09.002

Bingjie Guo MS , Mengyuan Li MS , Yingqing Feng PhD , Junying Yang MS , Hongwei Jiang PhD

Hypertension is one of the most significant preventable health risk factors globally. Among its various forms, monogenic hypertension, although rare, warrants attention. As awareness of monogenic hypertension grows within both the public and medical communities, research efforts are intensifying. Monogenic hypertension can primarily be categorized into three types: hypertension associated with abnormal distal renal tubular sodium transport, hypertension linked to adrenal steroid synthesis or receptor abnormalities, and other variants. These classifications are based on the functional impact and mutation type of the affected gene, with each category exhibiting distinct pathophysiological mechanisms and clinical manifestations. Recent advancements in gene sequencing technology have led to substantial progress in understanding monogenic hypertension. An increasing number of pathogenic genes have been successfully identified, providing a theoretical foundation for a deeper comprehension of the pathophysiological mechanisms underlying monogenic hypertension and for the development of novel treatment strategies.

高血压是全球最重要的可预防健康风险因素之一。在其各种形式中，单基因高血压虽然罕见，但值得注意。随着公众和医学界对单基因高血压的认识不断提高，研究工作也在不断加强。单基因高血压主要可分为三种类型：与远端肾小管钠转运异常相关的高血压，与肾上腺类固醇合成或受体异常相关的高血压，以及其他变体。这些分类基于受影响基因的功能影响和突变类型，每种类型都表现出不同的病理生理机制和临床表现。近年来，基因测序技术的进步使人们对单基因高血压的了解取得了实质性进展。越来越多的致病基因已被成功鉴定，为深入理解单基因高血压的病理生理机制和开发新的治疗策略提供了理论基础。

{"title":"Advances in research on monogenic hereditary hypertension","authors":"Bingjie Guo MS , Mengyuan Li MS , Yingqing Feng PhD , Junying Yang MS , Hongwei Jiang PhD","doi":"10.1016/j.amjms.2025.09.002","DOIUrl":"10.1016/j.amjms.2025.09.002","url":null,"abstract":"<div><div>Hypertension is one of the most significant preventable health risk factors globally. Among its various forms, monogenic hypertension, although rare, warrants attention. As awareness of monogenic hypertension grows within both the public and medical communities, research efforts are intensifying. Monogenic hypertension can primarily be categorized into three types: hypertension associated with abnormal distal renal tubular sodium transport, hypertension linked to adrenal steroid synthesis or receptor abnormalities, and other variants. These classifications are based on the functional impact and mutation type of the affected gene, with each category exhibiting distinct pathophysiological mechanisms and clinical manifestations. Recent advancements in gene sequencing technology have led to substantial progress in understanding monogenic hypertension. An increasing number of pathogenic genes have been successfully identified, providing a theoretical foundation for a deeper comprehension of the pathophysiological mechanisms underlying monogenic hypertension and for the development of novel treatment strategies.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 1","pages":"Pages 9-14"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Unravelling the “diabetes discrepancy”: The presence of chronic complications is a hallmark of worse short-term outcomes in patients with diabetes mellitus after transcatheter aortic valve replacement 揭示“糖尿病差异”：慢性并发症的出现是经导管主动脉瓣置换术后糖尿病患者短期预后较差的标志。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.09.004

Renxi Li BS, Brian G. Choi MD, MBA, FACC

Background

In transcatheter aortic valve replacement (TAVR), there is a notable “diabetes discrepancy”, where worse/better/similar outcomes were all found for patients with diabetes mellitus (DM). Such divergent findings pose a challenge for clinicians to accurately assess the risks for DM patients undergoing TAVR. We hypothesized the presence of chronic complications could be linked to worse post-TAVR outcomes in DM patients. Therefore, this study aimed to compare the short-term outcomes of TAVR between DM patients with chronic complications (DM-CC), those without complications (DM-NCC), and non-diabetic individuals (non-DM).

Methods

Patients who underwent TAVR were identified in National Inpatient Sample database from Q4 2015 to 2020. In-hospital post-TAVR outcomes were compared between DM-CC, DM-NCC, and non-DM. Multivariable logistic regression was used to adjust for demographics, socioeconomic status, primary payer status, hospital characteristics, transfer status, admission status, comorbidities and relevant diagnoses, and access site.

Results

There were 22,168 DM patients (9388 DM-CC and 12,780 DM-NCC) and 36,682 non-DM patients underwent TAVR. DM-CC were found to have worse outcomes than non-DM, which included adjusted risks of cardiac, neurological, pulmonary, and renal system complications, wound complications, hemorrhage, longer length of stay (LOS), and higher hospital charges. However, compared to non-DM, DM-NCC had lower in-hospital mortality, cardiac and renal system complications, infection, and superficial wound complications, as well as shorter LOS.

Conclusions

The presence of diabetic chronic complications could be a hallmark for worse short-term outcomes after TVAR, which may unravel the long-debated “diabetes discrepancy” in TAVR and provide insights into preoperative risk stratification for DM patients.

背景：在经导管主动脉瓣置换术（TAVR）中，存在明显的“糖尿病差异”，糖尿病（DM）患者的预后均较差/较好/相似。这些不同的发现对临床医生准确评估糖尿病患者接受TAVR的风险提出了挑战。我们假设慢性并发症的存在可能与糖尿病患者tavr后更差的结果有关。因此，本研究旨在比较有慢性并发症（DM- cc）、无并发症（DM- ncc）和非糖尿病患者（non-DM） TAVR的短期预后。方法：在2015年第四季度至2020年全国住院患者样本数据库中识别接受TAVR的患者。比较DM-CC、DM-NCC和非dm的住院tavr后结局。采用多变量logistic回归对人口统计学、社会经济状况、主要付款人状况、医院特征、转院状况、住院状况、合并症和相关诊断以及就诊地点进行调整。结果：22168例DM患者（DM- cc 9388例，DM- ncc 12780例）和36682例非DM患者行TAVR。DM-CC的预后比非dm更差，包括心脏、神经系统、肺和肾脏系统并发症、伤口并发症、出血、住院时间更长（LOS）和更高的住院费用。然而，与非糖尿病相比，DM-NCC具有更低的住院死亡率、心脏和肾脏系统并发症、感染和浅表伤口并发症，以及更短的LOS。结论：糖尿病慢性并发症的存在可能是TVAR术后短期预后较差的标志，这可能解开长期争论的TAVR“糖尿病差异”，并为DM患者的术前风险分层提供见解。

{"title":"Unravelling the “diabetes discrepancy”: The presence of chronic complications is a hallmark of worse short-term outcomes in patients with diabetes mellitus after transcatheter aortic valve replacement","authors":"Renxi Li BS, Brian G. Choi MD, MBA, FACC","doi":"10.1016/j.amjms.2025.09.004","DOIUrl":"10.1016/j.amjms.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>In transcatheter aortic valve replacement (TAVR), there is a notable “diabetes discrepancy”, where worse/better/similar outcomes were all found for patients with diabetes mellitus (DM). Such divergent findings pose a challenge for clinicians to accurately assess the risks for DM patients undergoing TAVR. We hypothesized the presence of chronic complications could be linked to worse post-TAVR outcomes in DM patients. Therefore, this study aimed to compare the short-term outcomes of TAVR between DM patients with chronic complications (DM-CC), those without complications (DM-NCC), and non-diabetic individuals (non-DM).</div></div><div><h3>Methods</h3><div>Patients who underwent TAVR were identified in National Inpatient Sample database from Q4 2015 to 2020. In-hospital post-TAVR outcomes were compared between DM-CC, DM-NCC, and non-DM. Multivariable logistic regression was used to adjust for demographics, socioeconomic status, primary payer status, hospital characteristics, transfer status, admission status, comorbidities and relevant diagnoses, and access site.</div></div><div><h3>Results</h3><div>There were 22,168 DM patients (9388 DM-CC and 12,780 DM-NCC) and 36,682 non-DM patients underwent TAVR. DM-CC were found to have worse outcomes than non-DM, which included adjusted risks of cardiac, neurological, pulmonary, and renal system complications, wound complications, hemorrhage, longer length of stay (LOS), and higher hospital charges. However, compared to non-DM, DM-NCC had lower in-hospital mortality, cardiac and renal system complications, infection, and superficial wound complications, as well as shorter LOS.</div></div><div><h3>Conclusions</h3><div>The presence of diabetic chronic complications could be a hallmark for worse short-term outcomes after TVAR, which may unravel the long-debated “diabetes discrepancy” in TAVR and provide insights into preoperative risk stratification for DM patients.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 1","pages":"Pages 15-22"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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

Changes in right heart load in patients with ARDS and the benefits of prone ventilation ARDS患者右心负荷的变化及俯卧位通气的益处。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2026-01-01 DOI: 10.1016/j.amjms.2025.08.007

Xiaonan Du MM , Taipu Guo MM , Shuaijie Pei MD , Yue Yang MM , Keliang Xie MD, PhD

Acute respiratory distress syndrome (ARDS) often occurs in the intensive care unit, and patients with ARDS have a poor prognosis due to severe hypoxemia caused by bilateral pulmonary oedema. Moreover, circulatory problems in patients with ARDS are a major concern for intensive care unit physicians. Due to increased pulmonary circulatory resistance, patients with acute respiratory distress syndrome usually exhibit increased right heart afterload, and patients with right heart failure usually develop Acute cor pulmonale(ACP). Prone ventilation is a common treatment for moderate-to-severe acute respiratory distress syndrome, and the prone position not only improves the patient’s oxygenation index but also reduces pulmonary circulatory resistance and relieves circulatory pressure through multiple pathways. This article summarises the factors that increase pulmonary circulatory resistance in patients with ARDS and the circulatory benefits of prone ventilation. The purpose of this study was to provide assistance in the management of patients with ARDS.

急性呼吸窘迫综合征（Acute respiratory distress syndrome， ARDS）多发生在重症监护室，由于双侧肺水肿导致严重低氧血症，ARDS患者预后较差。此外，急性呼吸窘迫综合征患者的循环系统问题是重症监护病房医生关注的主要问题。由于肺循环阻力增加，急性呼吸窘迫综合征患者常表现为右心负荷增加，右心衰竭患者常发展为急性肺心病（ACP）。俯卧位通气是中重度急性呼吸窘迫综合征的常用治疗方法，俯卧位不仅可以提高患者的氧合指数，还可以通过多种途径降低肺循环阻力，缓解循环压力。本文综述了增加ARDS患者肺循环阻力的因素以及俯卧位通气对循环的益处。本研究的目的是为ARDS患者的管理提供帮助。

{"title":"Changes in right heart load in patients with ARDS and the benefits of prone ventilation","authors":"Xiaonan Du MM , Taipu Guo MM , Shuaijie Pei MD , Yue Yang MM , Keliang Xie MD, PhD","doi":"10.1016/j.amjms.2025.08.007","DOIUrl":"10.1016/j.amjms.2025.08.007","url":null,"abstract":"<div><div>Acute respiratory distress syndrome (ARDS) often occurs in the intensive care unit, and patients with ARDS have a poor prognosis due to severe hypoxemia caused by bilateral pulmonary oedema. Moreover, circulatory problems in patients with ARDS are a major concern for intensive care unit physicians. Due to increased pulmonary circulatory resistance, patients with acute respiratory distress syndrome usually exhibit increased right heart afterload, and patients with right heart failure usually develop Acute cor pulmonale(ACP). Prone ventilation is a common treatment for moderate-to-severe acute respiratory distress syndrome, and the prone position not only improves the patient’s oxygenation index but also reduces pulmonary circulatory resistance and relieves circulatory pressure through multiple pathways. This article summarises the factors that increase pulmonary circulatory resistance in patients with ARDS and the circulatory benefits of prone ventilation. The purpose of this study was to provide assistance in the management of patients with ARDS.</div></div>","PeriodicalId":55526,"journal":{"name":"American Journal of the Medical Sciences","volume":"371 1","pages":"Pages 2-8"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 partnership for the ages 一个世代的伙伴关系：南方临床研究学会和美国医学科学杂志。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences

Pub Date : 2025-12-11 DOI: 10.1016/j.amjms.2025.12.778

Jesse Roman MD

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

American Journal of the Medical Sciences

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀