The American journal of the medical sciences最新文献

Background: Serum albumin plays a pivotal role in the exchange between interstitial and vascular compartments, and reduced levels of this biomarker appear to be associated with negative prognosis in septic patients. The correlation between the volume effect in sepsis therapy and the kinetics of serum albumin is unclear.

Aim: To investigate the relationship between serum albumin and fluid bolus in relation to its prognostic role in septic patients.

Methods: A single-center prospective observational study conducted from September 2022 to February 2024. All patients with sepsis admitted from the Emergency Department to the Intermediate Medical Care Unit (IMCU) were considered. Post-fluid bolus serum albumin was obtained after fluid bolus. The albumin value was correlated with the volume effect of the fluid bolus, and multivariate models were performed to evaluate its potential independent effect on 30-day mortality.

Results: 179 patients were enrolled. Pre-fluid bolus serum albumin was 2.55 g/dL (SD 0.51) with a multivariate OR for 30-day mortality of 1.170 (95 % CI 1.055-1.297, p = 0.003). After the fluid bolus, which resulted in a fluid balance percentage of +23.1 % (SD 7.1) and a mean Fractional Plasma Dilution of -0.48 (SD 0.18), albumin showed a mean decrease of -0.28 g/dL (SD 0.28) with a multivariate OR for 30-day mortality of 1.198 (95 % CI 1.065-1.348, p = 0.003). Post-fluid bolus albumin was negatively correlated with cumulative fluid balance and hemodilution.

Conclusions: The volume effect of fluid bolus is correlated with a decrease in serum albumin, and low albumin levels are associated with a high risk of mortality.

Background: Disparities have been shown in the outcomes of coronary artery bypass grafting (CABG) in racial minorities. Although Native Americans are known to have a higher risk for cardiovascular diseases, the current literature on CABG outcomes for Native Americans remains notably limited, probably due to their limited population size. Thus, this study aimed to investigate racial disparities in CABG outcomes among Native Americans.

Methods: Patients who underwent CABG were identified in National Inpatient Sample database from last quarter of 2015 to 2020. A 1:2 propensity score matching was conducted between Native Americans and Caucasians to address preoperative differences in demographics, socioeconomic status, comorbidity, and hospital characteristics. In-hospital outcomes, length of stay (LOS), time from admission to operation, and total hospital charge were compared.

Results: There were 905 (0.54 %) Native Americans and 125,983 (74.91 %) Caucasians, where 1,838 Caucasians were matched to all the Native Americans. The in-hospital mortality rate was elevated in Native Americans but was not statistically different (2.87 % vs. 2.23 %, p = 0.43). However, Native Americans had a higher risk of cardiogenic shock (8.51 % vs. 6.2 %, p = 0.03). There was no difference in time from admission to operation (2.55 ± 0.11 vs. 2.73 ± 0.08 days, p = 0.20), LOS (9.82 ± 0.23 vs. 9.95 ± 0.20 days, p = 0.65), or the total hospital charge between the two groups (205,594 ± 5192.8 vs. 213,961 ± 4150.9 US dollars, p = 0.20).

Conclusion: Native Americans had a significantly higher risk of cardiogenic shock after CABG. However, in-house mortality and other parameters were not affected. These disparities highlight challenges that Native Americans encounter and emphasize the need for targeted interventions to ensure health equity.

Background: Metabolic Syndrome (MetS) is an independent risk factor for cardiovascular disease. Perivascular fat depots not only serve as energy storage but also function as endocrine organs. Para-aortic adipose tissue (PAT), a perivascular local adipose tissue, has been suggested to play a role in obesity-mediated vascular disease, and has been associated with MetS components and measures of coronary and abdominal aortic calcification. PAT was previously described and examined using tomography and magnetic resonance imaging. This study aimed to describe the features of para-aortic adipose tissue measured echocardiographically in individuals with MetS.

Methods: Patients were divided into two groups according to their MetS status. The hypoechoic space in front of the ascending aorta was considered a PAT on the parasternal long-axis view. Possible covariates for the regression analysis were determined using the DAGitty diagram.

Results: A total of 494 patients were enrolled in this study. The PAT was significantly higher in the MetS group [9.6 (6.1/10.6) vs. 6.1 (0.9/9) mm, p < 0.001]. Logistic regression analysis revealed that PAT (OR=2,15, p = 0,003) was significantly associated with MetS. 7.55 mm of PAT has a sensitivity of 65 % and specificity of 65 % [AUC = 0.675, p < 0.001, 95 % CI (0.623-0.726)] in predicting the presence of MetS.

Conclusions: Based on the measurements obtained using this newly described modality in transthoracic echocardiography, its relationship with MetS was determined. These results can guide clinicians in diagnosing MetS.

Enteral nutrition is an important clinical nutritional supplementation method, especially for adult patients who are unable to eat normally or require additional nutritional support. However, many patients experience intolerance to enteral nutrition, such as delayed gastric emptying, bloating, and diarrhea, which not only affect the patient's nutritional status but also increase the risk of medical complications. In recent years, medical researchers have been dedicated to identifying and analyzing various factors that contribute to enteral nutrition intolerance, including the patient's disease status, nutritional formula, feeding method, and rate. In addition, research is also exploring the establishment of risk prediction models to more accurately predict which patients may develop enteral nutrition intolerance. These models typically combine clinical parameters, biomarkers, and patient individual characteristics, aiming to assist clinicians in better planning and adjusting nutritional treatment plans, thereby reducing the occurrence of intolerance events. This review summarizes the research progress on enteral nutrition intolerance in adult patients, with a focus on the latest developments in intolerance factors and risk prediction models, providing valuable guidance for clinical practice and helping improve patients' nutritional status and overall health.

A pancreatic fistula is defined as the leakage of pancreatic fluid into another organ or compartment because of pancreatic duct disruption or pseudocyst formation. It is most often seen in middle-aged men between 40 and 50, particularly in patients who have a history of chronic alcoholism and pancreatitis. The tract may fistulae into the pleura, creating a pancreaticopleural fistula, an exceedingly rare condition presenting as a recurrent pleural effusion and extremely high amylase levels, a key distinguishing factor in diagnosis. Here, we present such a case of a recurrent pancreaticopleural fistula and review the presentation, pathophysiology, diagnosis and treatment.

Alpha-gal syndrome develops in some individuals who have had tick bites which result in IgE responses to alpha-gal, a carbohydrate not found in humans. Patients with alpha-gal syndrome develop symptoms when they ingest mammalian meat, which contains this oligosaccharide. Often the response to this exposure is delayed and occurs 2 to 6 h post-ingestion. Symptoms can include skin rashes, urticaria, gastrointestinal symptoms, and occasionally anaphylaxis. In some patients, the initial site of the skin reaction is at the location of the prior tick bite. The frequency of the syndrome is uncertain but the geographic distribution is predominantly in areas with the lone star tick. The diagnosis depends on careful attention to the time interval between the ingestion of meat and the development of the symptoms. In addition, a history of prior tick bites is important for considering this diagnosis. Diagnostic studies include skin tests, serologic tests for specific IgE, and food challenges, with varying risks for anaphylaxis. The treatment of patients with acute presentations frequently includes intramuscular epinephrine, oral antihistamines, and corticosteroids. Long-term management involves diet modification with the elimination of meat. Patients can also have adverse reactions to medications, such as set cetuximab, heparin, monoclonal antibodies, and pancreatic enzymes, and clinicians will likely have difficulty identifying these reactions. If patients have a good response to diet modification and have a significant reduction in their specific IgE level to alpha-gal, they potentially can resume eating meat in their diet. This should be done under the direction of a specialist.

Background: Hypoxia-inducible factor-1α (HIF-1α) has an essential role in ventricular remodeling processes involving myocardial fibrosis and hypertrophy, but the clinical significance of HIF-1α levels in the early period after ST-segment elevation myocardial infarction (STEMI) for the prediction of left ventricular remodeling (LVR) has yet to be fully elucidated.

Objective: To investigate the predictive value of HIF-1α for LVR after STEMI based on the echocardiographic parameters.

Methods: In this prospective observational study, plasma samples were collected within 12 hours of onset from 183 patients with a first reperfused anterior ST-segment elevation myocardial infarction (STEMI), and HIF-1α levels were measured using enzyme-linked immunosorbent assay (ELISA). At baseline and 12 months after discharge, all patients underwent repeat echocardiography. The changes of echocardiography parameters from baseline to 12 months were used to reflect the changes of ventricular structure and function. An increase in end-diastolic volume of ≥20% was defined as LVR.

Results: The levels of HIF-1α were highly correlated with the changes of echocardiography parameters (ΔLVEF, ΔLVEDD, as well as ΔLVEDV). During the follow-up period, patients with higher HIF-1α concentrations had higher incidence of LVR, poorer ventricular function, and a lower MACE-free survival. Multivariate analysis showed the single-point HIF-1α was an independent predictor of LVR (odds ratio[OR]: 4.813; 95% CI: 1.553 to 14.918; P = 0.006). The HIF-1α levels predicted LVR with an AUC of 0.7905 (95% CI: 0.7067 to 0.8744; P < 0.0001). The combination of HIF-1α and N-terminal probrain natriuretic peptide (NT-proBNP) yielded a favorable increase in AUC to 0.8121 (95% CI: 0.7345 to 0.8896; P < 0.0001).

Conclusion: These results demonstrate that serum HIF-1α levels can predict LVR after STEMI independently.

Objective: Methionine synthetase (MS) A2756G and Cystathionine-β-synthase (CBS) 844ins68 gene polymorphisms were indicated to be associated with increased coronary artery disease (CAD) risk. Nevertheless, because the results of each experiment are different, there is no consensus till now. This meta-analysis aimed to clarify the relationship between MS gene A2756G and CBS gene 844ins68 polymorphisms and CAD.

Methods: 11,555 participants from 24 individual studies, 2162 participants from 6 individual studies were included in the MS gene A2756G and CBS 844ins68 gene polymorphisms meta-analysis respectively. To determine whether MS gene A2756G or CBS gene 844ins68 polymorphism was associated with CAD risk, a random or fixed-effect genetic model was adopted using pooled odds ratios (ORs) and their corresponding 95 % confidence intervals (CIs).

Results: MS gene A2756G polymorphism was significantly associated with CAD under recessive (OR: 1.400, 95 % CI: 1.119-1.751, P = 0.003) and homozygous genetic models (OR: 1.360, 95 % CI: 1.084-1.706, P = 0.008). In the African subgroup, the association was significant under the allelic, recessive, dominant, heterozygous, homozygous and additive (P < 0.05) genetic models. In the Asian subgroup, the association was significant under the allelic, recessive and homozygous genetic models (P < 0.05). No significant association was found between CBS 844ins68 gene polymorphism and CAD under all of the genetic models (P > 0.05).

Conclusions: MS gene A2756G polymorphism was significantly associated with increased CAD risk, especially in the African and Asian population. The G allele carriers of MS gene A2756G polymorphism were more susceptible to be suffered from CAD disease than others.

Background: This study aimed to investigate the potential impact of administering albumin and loop diuretics together on in-hospital mortality in septic shock patients.

Methods: Data from the MIMIC-IV database was used for a retrospective cohort study analyzing 3,298 adult septic shock patients. The Cox proportional hazards model and propensity score matching (PSM) were utilized to assess the relationship between loop diuretic administration and in-hospital mortality.

Results: The study found that septic shock patients who received albumin in combination with loop diuretic had a significantly lower in-hospital mortality rate compared to those who received albumin alone (19.4 % vs 33.1 %, p < 0.001). Administering diuretics after albumin infusion was associated with lower mortality rates. Optimal furosemide dosages of 10 to 40 mg daily were linked to the lowest mortality rates.

Conclusion: Co-administering albumin and loop diuretics in septic shock patients receiving high-dose crystalloids may be associated with reduced in-hospital mortality. Further investigation through a prospective randomized controlled trial is recommended to validate these findings.

To investigate the association between obesity and blood lead level (BLL) in the general population after controlled for menopause, blood pressure, calcium, and smoking; we assessed the relationship between BMI, WC (Waist Circumference), and blood lead levels in the non-smoking middle-aged subjects without hypertension among 2018 KNHANES. All data were recategorized into S1 (BMI<25 kg/m² & WC<90 cm), S2 (intermediate), and S3 (BMI>25 kg/m² & WC>90 cm). We made the log transformation of blood lead levels to bring them closer to a normal distribution. Logarithmic transformed BLL was closely related to BMI (p=.010) and WC (p=.020) after adjusting for sociodemographic, energy, working factors, and cardiometabolic variables. The prevalence of ratios of S3, S2, and S1 was comparable according to the quarterly group of BLL. Blood lead levels might increase oxidative stress on triglycerides and low high-density lipoprotein (HDL)-cholesterol; consequently, lead exposure might form peroxynitrite, a reactive oxygen substrate (ROS) susceptible to destroying lipids. Consequently, obesity was significantly correlated with logarithmic blood lead levels irrespective of sociodemographic, energy, working, and cardiometabolic factors in the non-smoking middle-aged population without hypertension. Further controlled clinical trials would be considered.