The American journal of the medical sciences最新文献

Background: The American Heart Association recently defined cardio-kidney-metabolic (CKM) syndrome as the intersection between metabolic, renal, and cardiovascular disease. Understanding the contemporary estimates of CKM related mortality in the US is essential for developing targeted public interventions.

Methods: We analyzed state-level and county-level CKM-associated all-cause mortality data (2010-2019) from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER). Median and interquartile (IQR) age-adjusted mortality rates (aaMR) per 100,000 were reported and linked with a multi-component metric for social deprivation: the Social Deprivation Index (SDI: range 0 - 100) grouped as: I: 0 - 25, II: 26 - 50, III: 51 - 75, and IV: 75 - 100. We fit pairwise comparisons between SDI groups and evaluated aaMR stratified by sex, race, and location.

Results: In 3101 counties, pooled aaMR was 505 (441-579). Oklahoma (643) and Massachusetts (364) had the highest and lowest values. aaMR increased across SDI groups [I: 454(404, 505), IV: 572(IQR: 495.9, 654.7); p < 0.001]. Men had higher rates [602 (526, 687)] than women [427 (368, 491)]. Metropolitan [476 (419, 542)] had lower rates than non-metropolitan counties [521 (454, 596)]. Non-Hispanic Black [637 (545, 731)] had higher rates than non-Hispanic White residents [497 (437, 570]. CKM associated aaMR remained reasonably constant between 2010 and 2019 (Mann Kendall test for trend p-value = 0.99).

Conclusions: In the US, CKM mortality disproportionately affects more socially deprived counties. Inability to reduce CKM mortality rates over the study period highlights the need for targeted policy interventions to curb the ongoing high burden.

Objective: The study aimed to investigate the impact of varying thyroid function statuses on clinical and laboratory indicators in patients with systemic lupus erythematosus (SLE).

Methods: A retrospective analysis was conducted on 258 patients with SLE, who were stratified according to thyroid function, renal involvement, and disease activity. The predictive value of thyroid hormones was evaluated using a receiver operating characteristic (ROC) curve.

Result: Among the 258 patients with SLE, 141 were classified as the normal group, while 117 exhibited thyroid hormone abnormalities, categorized into hypothyroidism (N=112) and hyperthyroidism (N=5) groups. Serum levels of FT3 and FT4 positively correlate with total protein and albumin, while negatively correlating with the SLE Disease Activity Index 2K (SLEDAI-2K) and 24-hour urinary protein (24hUP) (P<0.05). Compared to individuals without renal involvement, those with renal involvement exhibited lower levels of FT3 and FT4 (3.35±0.99 vs. 4.07±2.22, 12.92±3.14 vs. 14.63±3.39, P=0.001), along with elevated thyroid-stimulating hormone (TSH) levels (7.08±14.40 vs. 5.28±12.48, P=0.343). The subgroups in euthyroid (n=86) and hypothyroid (n=93) of SLE patients with renal involvement exhibited different characteristics (P<0.05). The levels of FT3 gradually decreased with increase of disease activity. The areas under the ROC curve of FT3, FT4, TSH and their combination were 0.651, 0.654, 0.643, 0.669, respectively (P<0.05).

Conclusions: The correlation between thyroid function and the severity of SLE is significant, SLE patients with hypothyroidism exhibit more pronounced disease manifestations and an elevated risk of organ damage. SLE patients with low levels of FT3 and FT4 are prone to progressing to nephritis.

Background: Patients with combined pulmonary fibrosis and emphysema (CPFE) may experience emphysema or fibrosis progression on chest computed tomography (CT). This study aimed to investigate the relationship and prognosis in CPFE patients with emphysema or fibrosis progression.

Methods: A total of 188 CPFE patients were included in our retrospective cohort study. The clinical presentations, radiographic features, and laboratory findings of the patients were reviewed.

Results: Among CPFE patients, 28.1% exhibited emphysema progression and 43.3% showed fibrosis progression. Different higher tumour markers were observed in the emphysema or fibrosis progression groups. Smoking, definite usual interstitial pneumonia (UIP), and total extent of emphysema were risk factors for emphysema progression. Age, definite UIP, and mediastinal lymph node enlargement were risk factors for fibrosis progression. Patients with fibrosis progression had worse prognoses than patients without fibrosis progression (HR 2.159; 95% CI, 1.243-3.749; P = 0.006). However, the prognosis was similar between patients with and without emphysema progression (HR 0.839; 95% CI, 0.429-1.641; P = 0.608). There was no significant interaction between emphysema and fibrosis progression (p > 0.05).

Conclusions: In CPFE patients, emphysema and fibrosis progression had different higher tumour markers, risk factors, and prognosis effects. There was no significant interaction between emphysema and fibrosis progression. Fibrosis progression had a deleterious effect on prognosis, whereas emphysema progression did not affect prognosis. Therefore, the primary objective of CPFE treatment should be to halt or even reverse the progression of fibrosis. CPFE may be primarily a fibrotic disease, with emphysema being an incidental complication.

Cancers of the oral cavity, lip, salivary gland, and oropharynx cause substantial global disease burden. While tobacco-use and alcohol use are highly associated with oral cancers, the rising incidence of disease in patients who do not use tobacco or alcohol points to additional carcinogenic risk factors. Chronic inflammation, disruption of the oral microbiome, and dysbiosis are becoming more widely implicated in the pathogenesis of oral cancer. Several studies have identified specific bacterial species enriched in patients with oral cancer, including Porphyromonas gingivalis and Fusobacterium nucleatum. In this narrative review, we describe potential carcinogenic mechanisms exhibited by these species and other microbes in the development of oral cancer.

Background: Catheter-directed interventions (CDIs) for pulmonary embolism (PE) continue to evolve. However, due to the paucity of data, their use has been limited in patients with underlying kidney disease.

Methods: The National Readmission Database (2016-2020) was utilized to identify intermediate to high-risk PE (IHR-PE) patients requiring CDI (thrombectomy, thrombolysis, and ultrasound-assisted thrombolysis). Cohorts were stratified based on the presence of CKD stage ≥3, including ESRD. A Propensity Score Matching (PSM) model was applied to compare outcomes.

Results: From 2016-2020, 20795 patients with IHR-PE underwent CDIs. Most were done in the non-CKD/ESRD population (N:18438, 88.7 %), while only 2357 (11.3 %) were done in the CKD/ESRD population. After propensity matching, the CKD/ESRD population had higher adverse events, including mortality (7.3 % vs. 5.1 %, p: 0.036), need for transfusions (52.6 % vs. 44.7 %, p < 0.001), and acute bleeding (15.4 % vs. 10.6 %, p < 0.001). CKD/ESRD population had a higher median LOS (5 vs. 4 days, p < 0.001) and total cost ($32935 vs. $29805, p < 0.001) in the index admission. Over the study period, total cost decreased in the CKD/ESRD population ($37829 to $31436, p-trend: 0.024) but remained the same in the non-CKD/ESRD population (p-trend>0.05). 180-day readmission rates were higher in the CKD/ESRD population (24.7 % vs. 17.5 %, p: 0.006). Our subgroup analysis, excluding ESRD patients, showed no significant difference in in-hospital mortality (6.5 % vs. 7.3 %, p > 0.05), but the rates of thoracic or respiratory bleeding (4.5 % vs. 2.6 %, p:0.012), need for transfusions (52.4 % vs.. 43.5 %, p < 0.001), and AKI (57.1 % vs. 23.2 %, p < 0.001) were higher in patients with CKD undergoing CDIs for IHF-PE.

Conclusion: CKD/ESRD patients requiring catheter-directed interventions for IHR-PE had higher periprocedural mortality and acute bleeding. The presence of ESRD mainly drove periprocedural mortality in our study, while the presence of non-dialyzed CKD was associated with higher rates of non-fatal localized hemorrhage.

Background: In late 2019, the World Health Organization declared Coronavirus disease 2019 a global emergency. Since then, many vaccines have been developed to combat the pandemic. Millions of people have received one of the approved COVID-19 vaccines; unfortunately, some adverse events also have been recorded.

Methods: In the local health system, patients could get either mRNA vaccines (either Pfizer-BioNTech or Moderna), adenoviral vector vaccine (AstraZeneca), or the vaccine based on inactivated virus (Sinovac). We investigated what immune-mediated adverse events occurred in our department after the COVID-19 vaccination.

Results: We evaluated six patients from our center who received mRNA vaccines and developed suspected immune-mediated adverse events. The immune-mediated adverse events are characterized by de novo or relapsing glomerular diseases and are further confirmed with percutaneous kidney biopsies. During A follow-up of more than two years, remission occurred in five patients, and glomerulonephritis persisted in one of them.

Conclusion: Vaccinations are pivotal in effectively protecting and preventing various epidemics. As such, it is essential to maintain a high level of vigilance concerning post-vaccination adverse events. This heightened level of suspicion leads to earlier detection, better understanding, and optimal prevention and management of these events. To this end, developing a specific vaccine/patient risk profile is necessary to categorize the target population selectively.

Background: The high mobilization failure rate with the mobilization strategy of combining chemotherapy and filgrastim (rhG-CSF) in autologous hematopoietic stem cell transplantation (auto-HSCT) in lymphomas is one of the unresolved issues. Whether the combination of polyethylene glycol filgrastim [pegfilgrastim (PEG-FIL), PEG-rhG-CSF] and filgrastim (FIL) improves the mobilization success rate and the timing of combination therapy has not been studied.

Methods: 107 lymphoma patients who received auto-HSCT were retrospectively enrolled and divided into groups of PEG+FIL and FIL. The group of PEG+FIL received pegfilgrastim (9 mg) on the third day of the chemotherapy, followed by filgrastim (10 μg/kg/day) based on the counts of peripheral blood stem cells (PBSC). The group of FIL received filgrastim 10 μg /kg/day depending on the number of PBSCs.

Results: The incidence of neutropenic fever in the group of PEG+FIL was significantly lower than in the group of FIL. The mean recovery time of leukocytes at autologous stem cell transplantation was significantly shorter in the group of PEG+FIL than in the group of FIL. Compared to the groups of FIL, the group of PEG+FIL had lower hospitalization costs. We found that the combination therapy is more recommended for patients with a bone marrow hematopoietic area of less than 30 %. Filgrastim is best administered 5-6 days after pegfilgrastim administration.

Conclusions: Compared to conventional filgrastim mobilization, the combination of pegfilgrastim and filgrastim schedule has high efficacy, non-inferior safety, and superior health economic benefits during auto-HSCT.

Objective: The present study aimed to explore the relationship between neutrophil count on admission and major adverse cardiovascular and cerebrovascular events (MACCE) and left ventricular ejection fraction (LVEF) during hospitalization in young ACS patients, which have rarely been investigated in previous studies.

Methods: This study included 400 young ACS patients (<45 years old) who underwent coronary angiography. According to the median neutrophil count at admission, the patients were divided into two groups. The relationship between neutrophil count and MACCE and LVEF during hospitalization was analyzed by regression analysis. The receiver operating characteristic (ROC) curve and the Youden index was used to determine the optimal cut-off value of neutrophil count.

Results: Neutrophil count at admission was an independent risk factor of in-hospital MACCE (OR: 1.33, 95% CI: 1.13-1.56, P<0.001) and LVEF <50% (OR: 1.28, 95% CI: 1.12-1.47, P<0.001) in young ACS patients.The cutoff value of neutrophil count for predicting the occurrence of in-hospital MACCE was 6.935 × 10^⁹/L with a sensitivity of 92.1%, specificity of 59.4%, and AUC is 0.820 (95% CI: 0.7587-0.8804, P<0.001), and for identifying the LVEF <50% was 8.660 × 10^⁹/L with a sensitivity of 69.8%, specificity of 76.8%, and AUC is 0.775 (95% CI: 0.6997-0.8505, P<0.001).

Conclusion: The neutrophil count upon admission is an independent predictor of in-hospital MACCE and LVEF in young ACS patients, giving important information for predicting the poor prognosis of young ACS patients.

Background: Current guidelines lack clarity about the optimal duration of octreotide therapy for patients with esophageal variceal hemorrhage (EVH). To address this lack of evidence, we conducted a randomized clinical trial (RCT) of 24-hr versus 72-hr continuous infusion of octreotide for patients with EVH.

Methods: This multi-center, prospective RCT (NCT03624517), randomized patients with EVH to 24-hr versus 72-hr infusion of octreotide. Patients were required to undergo esophageal variceal band ligation prior to enrollment. The primary endpoint was rebleeding rate at 72 hr. The study was terminated early due to an inability to recruit during and after the COVID-19 epidemic.

Results: For patients randomized to 72-hr (n = 19) of octreotide vs 24-hr (n = 15), there were no differences in the need for transfusion, average pRBC units transfused per patient (3 units vs 2 units), infection (5% vs 0%), mechanical ventilation (11% vs 7%), or the need for vasopressors (5% vs 3%), respectively (none of these differences were statistically significantly different). There were 2 re-bleeding events in the 72-hr group (11%), and no re-bleeding events in the 24-hr group (p = 0.49). 8/15 of patients receiving 24 hr of octreotide were discharged at or before hospital day 3 while none in the 72-hr group was discharged before day 3 (p < 0.001). There was one death (in the 72-hr group) within 30 days.

Conclusions: A 24-hr infusion is non-inferior to a 72-hr infusion of octreotide for prevention of re-bleeding in patients with EVH. We propose that shortened octreotide duration may help reduce hospital stay and related costs in these patients.