The American journal of the medical sciences最新文献

Purpose: By elucidating the association between specific PUFA and the risk of liver fibrosis, this study aims to provide a theoretical basis for nutritional interventions and risk stratification in diabetes populations with liver fibrosis.

Methods: Data for this cross-sectional study were obtained from the 2011-2014 NHANES database. We defined liver fibrosis through the FIB-4. The clinical cutoff was set at FIB-4 ≥ 1.3 for adults < 65 years and FIB-4 ≥ 2.0 for elderly patients aged ≥ 65 years. Different models were constructed using logistic regression analysis to explore the association of omega-6, omega-3, their subcategories, and the mega-6/omega-3 ratio with liver fibrosis in diabetes patients. Sensitivity analyses were performed using E-values. RCS analysis was employed to further explore the nonlinear relationship between associated PUFA and liver fibrosis.

Results: A total of 725 diabetes patients were included in the analysis, with 34.897% (253/725) classified in the indeterminate/high-risk liver fibrosis group. Logistic analysis indicated that the omega-6/omega-3 ratio and LNA may be associated with liver fibrosis (all P < 0.05). RCS results revealed that LNA was significantly related to liver fibrosis with a non-linear relationship (P for overall<0.001, P for nonlinear< 0.001). The omega-6/omega-3 ratio was significantly linked to liver fibrosis with a linear negative association (P for overall<0.05, P for nonlinear> 0.05).

Conclusions: The subcategory of omega-6- LNA and the omega-6/omega-3 ratio were associated with liver fibrosis in diabetes patients. Clinicians should monitor the omega-6/omega-3 ratio in diabetes patients and provide personalised management guidance for high-risk individuals.

Background: Mixed aortic valve disease (MAVD) is defined by the presence of concurrent aortic stenosis (AS) and aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) is effective in MAVD patients with mortality rates comparable to pure aortic stenosis (PAS). While most TAVR complications also occur at similar rates between the MAVD and PAS populations, recent studies have shown conflicting results.

Methods: A systematic literature review was conducted on PubMed and Embase for studies on the outcomes of TAVR in MAVD from inception until May 2024. Primary outcomes were short- and long-term mortality. Secondary outcomes were paravalvular regurgitation (PVR), vascular and bleeding complications, pacemaker implantation, and cerebrovascular complications. A random-effects model was used to pool risk ratios (RR) and 95% confidence intervals (CI).

Results: Eleven observational studies, including 133,558 patients, were included in the analysis. There were no significant differences in primary endpoints (p>0.05). MAVD was associated with a higher risk of paravalvular regurgitation (RR: 1.29, 95% CI: 1.07-1.55) and higher risk of vascular complications (RR: 1.20, 95% CI: 1.01-1.44). No significant differences were noted in other secondary outcomes (p>0.05), although there was a nonsignificant trend towards a decreased risk of cerebrovascular complications associated with TAVR in MAVD patients.

Conclusion: TAVR is an intervention with similar mortality and complication risk in MAVD and PAS patients. Future research is needed to further clarify the outcomes of TAVR in patients with MAVD, especially regarding cerebrovascular complications, long-term mortality, and the association of paravalvular regurgitation with mortality.

Background: Cardiometabolic index (CMI) is a novel marker reflecting metabolic and cardiovascular health, but its role in spondyloarthritis (SpA) remains unclear. This study aimed to investigate the association between CMI and SpA and its potential impact on individual health.

Methods: A total of 340 participants were included after propensity score matching, stratified into SpA and non-SpA groups. Baseline characteristics were analyzed, followed by collinearity analysis. The importance of CMI in SpA was assessed using two machine learning methods. Restricted cubic splines (RCS) and logistic regression analyses were conducted to evaluate the association between CMI and SpA. Interaction and subgroup analyses further examined potential modifying effects. The association of CMI with health-related quality of life (HRQoL) indicators was analyzed using regression models. Finally, mediation analysis was performed.

Results: CMI was significantly higher in the SpA group (P < 0.001) and emerged as the most influential factor in SpA classification models. RCS analysis demonstrated a positive association between CMI and SpA. Multivariate regression revealed that higher CMI tertiles were associated with increased SpA risk (T3 vs. T1: OR = 3.368, P = 0.001). Hypertension significantly modified this relationship (P for interaction = 0.046). Additionally, higher CMI was linked to poorer self-rated health and increased physically unhealthy days (P < 0.05). Mediation analysis indicated that SpA mediated the relationship between CMI and health outcomes.

Conclusions: CMI is associated with SpA and HRQoL indicators. SpA mediates the relationship between CMI and physical health, highlighting the importance of CMI in SpA risk assessment and patient management.

Background: Patients with cirrhosis and end-stage liver disease (ESLD) are highly susceptible to severe infections due to cirrhosis-associated immune dysfunction (CAID). The clinical features and outcomes of coccidioidomycosis in this population remain poorly described.

Methods: We conducted a retrospective cohort study of adults with cirrhosis and/or ESLD diagnosed with coccidioidomycosis between 2010 and 2025 at a tertiary referral center in California's San Joaquin Valley. Demographics, clinical features, diagnostics, management, and outcomes were abstracted from electronic health records.

Results: Forty-six patients met inclusion criteria. The mean age was 52 years, 74% were male, and 67% identified as Hispanic. Alcohol-related liver disease was the most common etiology, and 67% had decompensated cirrhosis. Respiratory symptoms predominated, with cough, dyspnea, and fever most frequent; 96% had abnormal chest imaging, most commonly diffuse infiltrates. Disseminated or complicated pulmonary disease occurred in 35%. Median diagnostic delay was 28 days. Antifungal therapy was given to 89% (primarily fluconazole); hepatotoxicity occurred in 26%. Hospitalization was required in 63%, ICU care in 24%, and relapse occurred in 24%. All-cause mortality was 33%, with a median time-to-death of 369 days.

Conclusions: Coccidioidomycosis in cirrhosis represents a high-risk clinical syndrome marked by delayed diagnosis, high rates of hospitalization, treatment complications, and significant mortality. Early recognition and optimized anti-fungal management are urgently needed, and prospective studies should define best practices for this vulnerable population.

Aim: To investigate the ultrasonographic (US) imaging of the lung parenchyma of patients with stable-period chronic obstructive pulmonary disease (COPD) and compare detected A-line and B-line artifacts (ALAs/BLAs) with those of a healthy-volunteer control group.

Materials and methods: Patients with stable-period COPD and healthy patients who presented to the Chest Diseases Clinic between May 2023 and June 2024 were included in the study. The clinical, demographic, spirometric, and radiologic characteristics of the patients were recorded. The patients were evaluated using US from a total of six predetermined anatomic lines, and ALA/BLA counts were recorded. Visual scoring [Goddard scores (GS)] was used for the assessment of emphysema on thorax computed tomography and images were graded from mild to severe (≤25 %- >75 %). Data of the COPD and control groups were compared with each other.

Results: A total of 44 patients with COPD with a mean age of 64.9 ± 8.5 years and 34 control group patients with a mean age of 61.7 ± 6.5 years were included in the present study. The average ALA and BLA was 4.7 ± 1.4 and 3.1 ± 1 in the COPD group and 3.7 ± 0.7 and 1 ± 0.1 in the control group, respectively (p = 0.001 and p < 0.001, respectively). A correlation was observed between GSs, which indicate the degree of emphysema, and ALA counts in the COPD group.

Conclusions: Some changes can be detected using US in COPD. ALA/BLA counts may increase in patients with COPD. US, which is an alternative modality to other conventional imaging modalities, may be useful in patients with stable COPD.

Background: The elevated average mean corpuscular volume (MCV) of adults with hemochromatosis and HFE p.C282Y (rs1800562) homozygosity is incompletely understood.

Methods: We retrospectively measured percentages of small (100.0-109.9 fL) and large (110.0-200.0 fL) macrocytes in automated hematology analyzer erythrocyte volume histograms of hemochromatosis probands with p.C282Y homozygosity and iron overload without cirrhosis. We evaluated associations of small and large macrocyte percentages with age, sex, body mass index (BMI), daily alcohol consumption, diabetes, hemochromatosis arthropathy, transferrin saturation (TS), and serum ferritin (SF) at diagnosis.

Results: There were 69 probands (46 men, 23 women) of mean age 49±15 y. Median BMI was 27.5 kg/m² (16.9, 46.3). Ten probands (14.5%) had diabetes and seven (10.1%) had arthropathy. Mean TS, SF, and MCV were 81±14%, 791±480 µg/L, and 95.5±4.1 fL, respectively. Mean small and large macrocyte percentages were 17.9±14.3% and 31.3±8.2%, respectively. Correlations of small and large macrocyte percentages with age were significant (r₆₉=0.3937; p=0.0008 and r₆₉=0.2634; p=0.0288, respectively). The mean small macrocyte percentage of 11 probands who reported daily alcohol consumption was greater than that of the 58 other probands (20.6±2.9% and 17.4±4.4%, respectively; p=0.0070). The correlation of large macrocyte percentages with TS was significant (r₆₉=0.2661; p=0.0271). Linear regressions confirmed these positive associations: small macrocyte percentages with age (p=0.0012) and daily alcohol consumption (p=0.0355); and large macrocyte percentages with age (p=0.0306) and TS (p=0.0247).

Conclusion: In HFE p.C282Y homozygotes, small macrocyte percentages are associated with age and daily alcohol consumption and large macrocyte percentages are associated with age and TS.