Am. J. Med. Sci. [JOURNAL]
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200 papers
A rare presternal goiter: presentation and literature review.
Naraynsingh V, Maharaj M, Hassranah S … +2 more , Maharajh S, Maharaj R
Am J Med Sci · 2025 Nov · PMID 40675371 · Publisher ↗
Presternal goiters are incredibly rare presentations worldwide; very little is known about their genesis despite many hypotheses and even fewer cases are seen in our medical literature. The commonest pathology for preste...
Presternal goiters are incredibly rare presentations worldwide; very little is known about their genesis despite many hypotheses and even fewer cases are seen in our medical literature. The commonest pathology for presternal goiters is papillary carcinoma of the thyroid (PCT), typically presenting as a solitary cystic cervical mass. Differential diagnoses are vast causing diagnostic difficulty, prompting crucial pre-operative radiological investigations and pathological confirmation. Curative management in all cases of malignant presternal goiters is total thyroidectomy with a modified radical neck dissection where indicated. Post operative radioiodine ablation and suppressive thyroxine therapy are often used and serial thyroglobulin surveillance is done. Interestingly, this is the first documented case in which previous cardiac surgery with mediastinal scarring and deficiency in the deep cervical fascia maybe predisposing factors. Therefore, we propose two new theories in the causation of this rare phenomenon.
Double-filtration plasmapheresis versus therapeutic plasma exchange in the treatment of anti-glomerular basement membrane nephritis: A cohort study.
Liu C, Wei W, Huang Y … +8 more , Li X, Huang X, Yang L, Chen Z, Yang Y, Fu P, Zhang L, Zhao Y
Am J Med Sci · 2025 Oct · PMID 40675370 · Publisher ↗
BACKGROUND: Therapeutic plasma exchange (TPE) is acknowledged as the standard therapy for anti-glomerular basement membrane (GBM) nephritis. In recent years, double-filtration plasmapheresis (DFPP) has been proposed as a...
BACKGROUND: Therapeutic plasma exchange (TPE) is acknowledged as the standard therapy for anti-glomerular basement membrane (GBM) nephritis. In recent years, double-filtration plasmapheresis (DFPP) has been proposed as an equally effective plasmapheresis modality. The present study aimed to compare the efficacy and safety of TPE and DFPP for the treatment of anti-GBM nephritis. METHODS: We conducted a retrospective cohort study of anti-GBM patients who received plasmapheresis from February 2011 to October 2023 at West China Hospital of Sichuan University. The primary outcome was a composite endpoint of in-hospital death or dialysis dependency at discharge. The secondary outcomes included length of hospitalization, long-term mortality and end-stage renal disease (ESRD). We also compared anti-GBM antibody titer reduction, plasmapheresis-related adverse events. Logistic regression and Cox hazard proportional regression analyses were performed to investigate potential risk factors of primary outcome and long-term patient/renal survival. RESULTS: In total, 58 anti-GBM nephritis patients were included in this study. No significant differences were observed in the incidence of primary outcome between patients receiving DFPP and TPE in fully adjusted logistic regression model (OR=0.23, 95 % CI=0.04-1.37, P = 0.106). In surviving patients, the length of hospitalization was similar (21 vs. 23 days, P = 0.165). With a follow-up of 3-years, K‒M survival analysis revealed similar risk of death or ESRD between the 2 groups (P = 0.424; P = 0.987). According to fully adjusted Cox regression analyses, anti-GBM nephritis patients receiving DFPP achieved comparable patient (HR=1.18, 95 % CI=0.23-6.04; P = 0.845) and kidney survival (HR=0.96, 95 % CI=0.13-6.86; P = 0.967) to those receiving TPE. After plasmapheresis treatment, the anti-GBM antibody concentration significantly decreased in both groups (DFPP: 136.47 vs 27.20 AU/mL, P < 0.001; TPE: 122.09 vs 27.40 AU/mL, P = 0.016), with fewer allergy episodes observed in the DFPP group (13.64 % vs 42.86 %, P = 0.049). Besides, older age and concomitant infection were independently related to 3-year patient mortality (P < 0.001, P = 0.031), whereas high-dose methylprednisolone treatment seemed to be associated with a lower risk of ESRD (P = 0.034). CONCLUSIONS: Anti-GBM nephritis patients who received DFPP achieved comparable short- and long-term prognosis to those who received TPE. With less plasma consumption, DFPP was also associated with fewer allergy episodes. DFPP might be an alternative modality of plasmapheresis for anti-GBM nephritis, especially in the setting of limited blood resources.
Transcatheter edge-to-edge repair in patients with mitral annular calcification: A systematic review and meta-analysis.
Idowu A, Adebolu O, Siraj B … +7 more , Wattanachayakul P, Balogun O, Lo KB, Witzke C, Akintoye E, Bozorgnia B, Pressman G
Am J Med Sci · 2025 Nov · PMID 40675369 · Publisher ↗
BACKGROUND: Mitral annular calcification (MAC) is common in patients with functional mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair (TEER). However, the safety and effectiveness of TEER sy...
BACKGROUND: Mitral annular calcification (MAC) is common in patients with functional mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair (TEER). However, the safety and effectiveness of TEER systems in patients with MAC is poorly understood. METHODS: We systematically reviewed multiple online databases to identify studies that reported outcomes in patients undergoing TEER with underlying moderate/severe MAC versus those with no/mild MAC. Random-effect model meta-analysis at a 95 % confidence interval was done via Cochrane Review Manager 5.4. RESULTS: A total of 6 studies with a pooled 2808 patients (no/mild MAC: 84.5 % vs moderate/severe MAC: 15.5 %) were included. Compared to those with no/mild MAC, patients undergoing TEER with moderate/severe MAC have an insignificant trend towards a lower immediate procedural success (OR: 0.62, 95 % CI: 0.37 - 1.04, p = 0.07). After one year of TEER, the two groups had similar rates of repeat mitral valve intervention or surgery (OR: 1.67, 95 %CI: 0.92 - 3.05, p = 0.09), sustained clinical improvement (NYHA ≤ 2) (OR: 0.86, 95 %CI: 0.64 - 1.15, p = 0.30), and heart failure re-admission (OR: 0.84, 95 %CI: 0.52 - 1.36, p = 0.48). All-cause mortality was, however, higher in the moderate/severe MAC patients (OR: 1.82, 95 %CI: 1.15 - 2.86, p = 0.01). CONCLUSIONS: TEER appears safe and effective in carefully selected patients with significant MAC. A standardized selection algorithm is needed to identify MAC patients that would benefit most from TEER.
Grit and resilience among pulmonary and critical care physicians: A multi-institutional study.
Hu AW, Beckman TJ, LeMahieu AM … +8 more , Keetley HM, Adamson R, Patel HH, Krutsinger DC, Denson JL, Dhannoon S, Chu DC, Kelm DJ
Am J Med Sci · 2025 Nov · PMID 40675368 · Publisher ↗
BACKGROUND: Pulmonary and Critical Care Medicine (PCCM) physicians work in stressful environments and are at risk for burnout. Grit and resilience have been shown to protect against burnout in various medical specialties...
BACKGROUND: Pulmonary and Critical Care Medicine (PCCM) physicians work in stressful environments and are at risk for burnout. Grit and resilience have been shown to protect against burnout in various medical specialties, but this relationship has not been explored among PCCM physicians. The purpose of this study was to determine associations between grit and resilience with burnout, academic productivity, and COVID-19-related clinical experiences in PCCM fellows and faculty. METHODS: A cross-sectional, multi-institutional survey was conducted during the 2022-2023 academic year among PCCM fellows and faculty from six academic institutions. Measures included the Short Grit Scale, Connor-Davidson Resilience scale, single-item measures of emotional exhaustion and depersonalization, ICU-level COVID-19 experience, and academic productivity metrics. Mixed-effects proportional odds regression models assessed relationships between grit, resilience, burnout, and academic performance, considering clustering within institutions. RESULTS: One hundred and thirty-one participants were surveyed with a response rate of 40.3 %. Median scores for grit, burnout, and resiliency were 3.8 (0-5), 4 (0-12), and 31 (0-40), respectively. Higher grit correlated with less burnout (OR=0.34, p < 0.001), fewer PubMed publications (OR = 0.57, p = 0.048), and more national or international presentations (OR = 1.99, p = 0.027). Higher resilience was associated with less burnout (OR = 0.90, p = 0.001). CONCLUSIONS: This is the first study to examine grit and resilience in the field of PCCM. Higher grit and resilience were associated with less burnout in PCCM physicians. Additionally, physicians with higher grit and resilience scores experienced more COVID-19 related deaths. Given the intense and emotionally taxing nature of PCCM, further research on interventions to optimize grit and resilience in PCCM physicians is needed.
COPET study findings regarding the clinical relevance of biomass exposure as an etiotype in COPD.
Yazar EE, Demirci N, Yiğitbaş BA … +18 more , Çalıkoğlu M, Gülbaş G, Turan MO, Şahin H, Sarıoğlu N, Hoca NT, Bozkuş F, Tural S, Mirici NA, Ogan N, Yormaz B, Öztürk A, Koşar F, Akpınar EE, Günlüoğlu G, Mete B, Öztürk C, Süerdem M
Am J Med Sci · 2025 Oct · PMID 40645336 · Publisher ↗
PURPOSE: The finding that COPD can also develop in non-smokers has led to further investigations of etiologic causes other than smoking. This study evaluated the relationship between tobacco smoking and/or biomass-burnin...
PURPOSE: The finding that COPD can also develop in non-smokers has led to further investigations of etiologic causes other than smoking. This study evaluated the relationship between tobacco smoking and/or biomass-burning smoke exposure (BBS) and the demographic, clinical, and prognostic characteristics of individuals with COPD. METHODS: A total of 1129 stable COPD patients from the COPET study were retrospectively analyzed. The patients were divided into three groups: the COPD-B group (n = 52), which included patients who were solely BBS; the COPD-C group (n = 634), which included patients who exclusively tobacco smoking; and the COPD-BC group (n = 443), which included patients with both BBS and tobacco smoking. RESULTS: The average age of the patients was 65.8 ± 9.1 years, and 87.4 % of them were men. In the COPD-B group, the following factors were significantly greater compared to the COPD-C and COPD-BC groups: age (p = 0.001), BMI (p = 0.001), percentage of female patients (p < 0.001), FEV/FVC ratio (p = 0.014), eosinophil count (p < 0.001), ADO score (p < 0.001), and the proportion of patients with frequent exacerbations (p = 0.013). Thorax CT scans showed that the COPD-BC group had a greater incidence of bronchiectasis and emphysema than the COPD-B and COPD-C groups (p < 0.001). CONCLUSIONS: This study highlights significant clinical and radiological differences among COPD patients based on tobacco smoking and BBS, which may substantially impact COPD outcomes, including exacerbations and prognosis.
Intranasal administration of stem cell therapy: A promising approach for early Alzheimer's disease intervention.
Fatima E, Fatima A
Am J Med Sci · 2025 Oct · PMID 40639583 · Publisher ↗
Abstract loading — click title to view on PubMed.
Cost analysis of mechanical thrombectomy vs catheter-directed thrombolysis vs anticoagulation alone for pulmonary embolism.
Kattih Z, Meredith S, Dong V … +8 more , Roselli V, Mina D, Stefanov D, Thampi S, Kodra A, Kliger C, Mina B, Lenox Hill Hospital Pulmonary Embolism Response Team (PERT)
Am J Med Sci · 2025 Oct · PMID 40623652 · Publisher ↗
INTRODUCTION: Pulmonary embolism is the third most common cause of cardiovascular death in the US with a high financial burden. Data on cost-analysis is limited in comparing advanced treatment modalities. METHODS: A coho...
INTRODUCTION: Pulmonary embolism is the third most common cause of cardiovascular death in the US with a high financial burden. Data on cost-analysis is limited in comparing advanced treatment modalities. METHODS: A cohort of patients were selected from a PERT registry database from cases at a tertiary center in a metropolitan area between 2016 and 2023. Patients were treated with either anticoagulation alone, CDT, or MT. The primary outcome was revenue-per-case. RESULTS: MT had the highest revenue-per-case, with a median (IQR) of $59,058 ($42,827-$86,950) (p < 0.0001). CDT had a median (IQR) revenue-per-case of $19,007 ($14,062-$34,651). Anticoagulation alone had a median (IQR) revenue-per-case of $16,171 ($12,666-$31,473). Margin-per-case closely paralleled the primary outcome. While hospital length of stay, survival at discharge, and 90-day readmission were not different among the groups, ICU utilization was 20 % in anticoagulation patients, 100 % in CDT patients, and 24 % in MT patients (p < 0.0001). CTEPH was identified in 12 % of the anticoagulation group, 12 % of the CDT patients, and none of the MT patients (p = 0.04). DISCUSSION: MT has a significantly higher revenue-per-case compared with anticoagulation alone and CDT. ICU utilization of mechanical thrombectomy was lower than catheter-directed thrombolysis and near the ICU utilization with anticoagulation alone. Institution policies and device choice may impact these outcomes, which may vary by center. CONCLUSIONS: Advanced therapies that can prevent the downstream sequalae of PE have higher cost but may be more advantageous, and further research is required to evaluate long term benefits.
An analysis of studies comparing myocarditis and pericarditis in COVID-19 vaccinated and SARS-CoV-2 infected individuals.
Bowyer W, Haslam A, Prasad V
Am J Med Sci · 2025 Oct · PMID 40623651 · Publisher ↗
We sought to identify studies that examined myocarditis and pericarditis after both COVID-19 vaccination and SARS-CoV-2 infection. A literature search was conducted, and retrospective cohort studies examining incidence r...
We sought to identify studies that examined myocarditis and pericarditis after both COVID-19 vaccination and SARS-CoV-2 infection. A literature search was conducted, and retrospective cohort studies examining incidence rates for myocarditis and pericarditis after both COVID-19 vaccination and SARS-CoV-2 infection were included. The methodologies and conclusions of each study was assessed, and a risk of bias was determined. We found 6 articles that utilized cohorts of both vaccinated and infected populations. Of the included articles, all of them had risk of bias concerns, with 50 % having a poor-quality rating and 50 % having a fair quality rating. Methodological biases, including reliance on electronic health record data, inadequate observational periods, and failure to account for baseline characteristics between the two cohorts, were observed across studies. Ultimately, these methodological limitations lead to hyperinflated myocarditis rates in the infection cohorts and a lack of meaningful comparisons between the infection and vaccination cohorts.
Impact of inhaler treatments on respiratory functions and exacerbation frequency in non-cystic fibrosis bronchiectasis.
Fidan U, Kızılırmak D, Şakar Coşkun A
Am J Med Sci · 2025 Oct · PMID 40518077 · Publisher ↗
BACKGROUND: Bronchiectasis is a chronic airway disease caused by abnormal and permanent dilation of the airways. This study aimed to evaluate the effects of inhaler therapy use on respiratory functions and clinical outco...
BACKGROUND: Bronchiectasis is a chronic airway disease caused by abnormal and permanent dilation of the airways. This study aimed to evaluate the effects of inhaler therapy use on respiratory functions and clinical outcomes in patients with non-cystic fibrosis bronchiectasis. METHODS: One hundred forty-six patients with non-cystic fibrosis bronchiectasis aged over 18 years, diagnosed using high-resolution computed tomography, were included in the study. Age, sex, body mass index, smoking status, additional diseases, known etiologic factors, and vaccination status of the patients included in the retrospectively designed study were recorded as sociodemographic data. Respiratory functions, disease severity, and clinical outcomes of patients with bronchiectasis who did and did not receive inhaled anticholinergic and steroid treatments were compared. RESULTS: Ninety (61.6 %) of the 146 patients included in the study were women. The mean age was 56.14 ± 16.22 years. The etiology of bronchiectasis was unknown in 78 (53.4 %) patients. The most prevalent comorbidity was asthma. According to modified Reiff scoring, 91 (62.3 %) patients were classified as having mild bronchiectasis. Twenty-six (17.8 %) patients had airway obstruction. There were 93 (63.7 %) patients using inhaled corticosteroids and 32 (21.9 %) using inhaled anticholinergics. CONCLUSIONS: It was determined that patients using inhaler anticholinergics or inhaled steroids were in the more severe group. However, inhaler anticholinergic and inhaler steroid treatments had no effect on hospital admissions and exacerbation frequency in patients with bronchiectasis. Hospitalizations were more frequent among patients with bronchiectasis using inhaled steroids.
Association of hepatitis B virus infection and helicobacter pylori co-infection with gastric disorders and cancer.
Wu X, Yu J, Luo X … +1 more , Lan Y
Am J Med Sci · 2025 Sep · PMID 40518076 · Publisher ↗
BACKGROUND AND AIMS: The relationship between hepatitis B virus (HBV) and gastric disorders remains elusive. This study aimed to assess the associations between HBV infection and three gastric disorders. To our knowledge...
BACKGROUND AND AIMS: The relationship between hepatitis B virus (HBV) and gastric disorders remains elusive. This study aimed to assess the associations between HBV infection and three gastric disorders. To our knowledge, this is among the first studies to report a synergistic association between HBV and HP co-infection and gastric cancer risk. METHODS: HBV-positive patients (n = 352) and HBV-negative controls (n = 520) were recruited from June 2018 to May 2020 at the People's Hospital of Qijiang District. All patients were examined with gastroscopy and histopathological analysis was performed on gastric specimens. HBV DNA and hepatitis B virus surface antigen (HBsAg) were detected by qPCR and the enzyme-linked immunosorbent assay (ELISA), respectively. The relationship of HBV infection with gastric disorders was evaluated by logistic regression analysis. Survival and relapse rates of HBV gastric cancer (GC) cases were estimated using the Kaplan-Meier survival curve and Cox proportional hazard regression model. RESULTS: Gastric mucosal lesions were more serious in the HBV-positive group than in the HBV- negative groups (P < 0.05). HBV DNA and HBsAg levels were strongly correlated with the manifestation of gastritis, gastric ulcer, and GC, and were the highest in GC patients. HBV and Helicobacter Pylori (HP) infections were identified as risk factors for GC (P < 0.05). HBV was significantly associated with gastric ulcer (OR = 10.51, 95 % CI = 5.66-19.52, p < 0.01) and gastric cancer (OR = 2.21, 95 % CI = 1.21-3.47, p = 0.037), while co-infection with HP further increased GC risk (OR = 3.39, 95 % CI = 1.71-6.12, p < 0.01). CONCLUSIONS: HBV infection was correlated with some gastric lesions. HBV infection alone might be a risk factor of GC. HBV infection potently increases the risk of GC in HP-positive patients.
Therapeutic efficacy of scopoletin on oxidative stress and cardiac dysfunction in streptozotocin-induced diabetic rats.
Alqudah A, Qnais E, Gammoh O … +6 more , Bseiso Y, Wedyan M, Shilbayeh SAR, Abudalo R, Oqal M, Aljabali AAA
Am J Med Sci · 2025 Nov · PMID 40518075 · Publisher ↗
BACKGROUND: Cardiac dysfunction associated with diabetes often arises as a serious condition, primarily driven by persistent oxidative imbalance and chronic inflammation. There are few treatments for such complication an...
BACKGROUND: Cardiac dysfunction associated with diabetes often arises as a serious condition, primarily driven by persistent oxidative imbalance and chronic inflammation. There are few treatments for such complication and therefore, there is considerable interest in natural compounds such as scopoletin has antioxidative and anti-inflammatory activities. This study investigates how scopoletin may influence disease progression in a rat model of diabetic cardiomyopathy induced by streptozotocin (STZ). METHODS: Thirty-two male Wistar rats were evenly distributed into four study groups using a randomization protocol: a non-diabetic control, an untreated diabetic group, a diabetic group administered scopoletin, and a diabetic group treated with metformin (Glucophage) as a reference therapy. Post-diabetes induction by streptozotocin, treatments were administered for three weeks, subsequently, malondialdehyde (MDA) concentrations were measured along with, the enzymatic activities of key cardiac antioxidants-superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx)-were evaluated to assess oxidative defense status. ATPase activities, gene expression (p53 and VCAM-1), and histopathological examinations of heart tissues. RESULTS: Scopoletin treatment significantly reduced MDA levels by up to 35 %, with p < 0.01 compared to the diabetic control. Antioxidant enzyme activities were notably enhanced, with increases in SOD, CAT, and GPx activities by approximately 50 % (p < 0.01). Cardiac ATPase activities showed marked improvement (p < 0.05), and the expression of p53 and VCAM-1 was effectively downregulated (p < 0.01). Histopathological analysis revealed substantial reductions in myocardial damage, vacuolation, and tissue congestion in scopoletin-treated groups, with the high-dose effects comparable to those observed with metformin (Glucophage). CONCLUSIONS: Scopoletin demonstrates significant potential in treating diabetic cardiomyopathy. These results encourage further clinical trials to explore scopoletin as a complementary therapy for cardiac complications in diabetic patients.
Effect of genetic liability to migraines on spontaneous coronary artery dissection and fibromuscular dysplasia.
Chen YH, Yan F
Am J Med Sci · 2025 Oct · PMID 40516917 · Publisher ↗
BACKGROUND: Associations among migraines, spontaneous coronary artery dissection (SCAD), and fibromuscular dysplasia (FMD) have been reported; however, their causality is inconclusive. METHODS: We inferred a causal relat...
BACKGROUND: Associations among migraines, spontaneous coronary artery dissection (SCAD), and fibromuscular dysplasia (FMD) have been reported; however, their causality is inconclusive. METHODS: We inferred a causal relation between exposure (migraines) and outcomes (SCAD and FMD) using two-sample MR analysis. Mediation analysis was performed using reverse and multivariate MR analysis methods. Finally, using two-sample MR analysis, we explored whether the currently perceived potential risk factors for SCAD and FMD mediate the aforementioned causal association. RESULTS: Inverse Variance Weighted (IVW) analysis showed that migraines increased the risk of developing SCAD and FMD. SCAD increases the risk of developing FMD. Reverse causality or pleiotropy was not observed. Multivariate random IVW analysis showed that the effect of migraine on FMD was no longer significant in the multivariate model, whereas the effect of SCAD remained significant. SCAD mediated the causal association between migraine and FMD, with a mediating effect of 0.119 and a proportion of 18.30 %. IVW analyses did not find direct evidence that these associations were consistently related to other potential pathogenic factors of SCAD or FMD. CONCLUSIONS: Migraines are a risk factor for both SCAD and FMD, whereas SCAD is an incomplete mediator of the causal relation between migraine and FMD. However, mechanistic studies are warranted to investigate this link.
Increased prevalence, ER visits, and hospitalizations in medicare systemic lupus erythematosus patients living in socially vulnerable counties: A cross-sectional study.
Cosentino ER, Oates Jim JC
Am J Med Sci · 2025 Sep · PMID 40514311 · Full text
BACKGROUND: Systemic Lupus Erythematosus (SLE) disproportionately affects women, minorities, and individuals with low socioeconomic status. We hypothesized that counties with a higher percentage of disadvantaged individu...
BACKGROUND: Systemic Lupus Erythematosus (SLE) disproportionately affects women, minorities, and individuals with low socioeconomic status. We hypothesized that counties with a higher percentage of disadvantaged individuals have a higher prevalence of SLE and increased acute hospital events, including emergency room (ER) visits and hospitalizations, among Medicare patients with SLE. METHODS: This cross-sectional study used the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) and Lupus Research Alliance's Lupus Index Medicare data. SLE was identified through Medicare fee-for-service administrative records from 2016 containing two or more ICD-10 codes for SLE. We examined SLE prevalence, acute hospital events, and their association with county-level SVI rankings. RESULTS: The study population was 89 % female and 69 % White, with 22 % Black. SVI ranking (r = 0.508) and its subthemes correlated with SLE prevalence, with socioeconomic status and household composition showing the strongest associations (R = 0.431 and R = 0.365, respectively). Similar but weaker correlations were seen between SVI and acute healthcare events, including ER visits and hospitalizations. Limitations include the cross-sectional design preventing longitudinal analysis, reliance on administrative data potentially introducing bias, and exclusion of counties with fewer than 10 SLE patients. CONCLUSIONS: This is the first study linking county-level vulnerability to SLE prevalence and healthcare events in a Medicare SLE population. Findings suggest that social and environmental factors influence SLE risk and healthcare utilization, much like other chronic diseases. The modest association between location and hospital/ER events suggests that structural factors may act as barriers to optimal care and outcomes.
Increased susceptibility to vibrio vulnificus infection in patients with MASLD, cirrhosis, and chronic liver diseases.
Aldiabat M, Kilani Y, Madi MY … +5 more , Saha P, Roy S, Rockey DC, Chatterjee S, Syn WK
Am J Med Sci · 2025 Sep · PMID 40482969 · Publisher ↗
Abstract loading — click title to view on PubMed.
Diagnostic value of novel thrombus markers in COPD with deep venous thrombosis.
Huang J, Huang J, Sun C … +2 more , Tian F, Wang J
Am J Med Sci · 2025 Sep · PMID 40480301 · Publisher ↗
BACKGROUND: This study assesses the diagnostic value of new thrombosis markers, including thrombin antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activ...
BACKGROUND: This study assesses the diagnostic value of new thrombosis markers, including thrombin antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC), for the incidence prediction of deep venous thrombosis (DVT) of lower limb in chronic obstructive pulmonary disease (COPD) patients. METHODS: 98 patients with COPD admitted to Shenzhen Guangming district people's hospital from March 2020 to May 2022 and were selected and divided into a non-DVT group (n = 62) and a DVT (n = 36) group. A control group consisting of 50 healthy subjects were recruited. The blood sugar and lipid metabolic indicators of patients in each group were analyzed and compared. ROC curve analysis was performed to assess the diagnostic efficacy of new thrombosis markers. RESULTS: There were no significant differences in the levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) among the three groups. The DVT group exhibited higher levels of fibrin degradation product (FDP) and D-dimer (D-D) than the non-DVT group. The plasma levels of TAT, PIC, TM, and t-PAIC in the DVT group significantly elevated compared to the other two groups. Combined diagnosis of TAT and TM displayed superior diagnostic efficacy with maximum AUC values (0.833) and a sensitivity of 87.5 %. CONCLUSIONS: The detection of serum levels of TAT, PIC, TM, and t-PAIC have diagnostic value in COPD patients with DVT.
Elevated blood anandamide levels in acute COVID-19 pneumonia with respiratory failure.
Basu A, Pommerolle L, Arif M … +9 more , Meliton AY, Udofia I, Wu D, Mutlu GM, Gochuico BR, Summer R, Adegunsoye A, Burnham EL, Cinar R
Am J Med Sci · 2025 Sep · PMID 40480300 · Full text
BACKGROUND: Subsets of COVID-19 pneumonia patients with acute respiratory failure experienced long-term respiratory dysfunction and persistent radiological abnormalities. However, mechanisms contributing to persistent pu...
BACKGROUND: Subsets of COVID-19 pneumonia patients with acute respiratory failure experienced long-term respiratory dysfunction and persistent radiological abnormalities. However, mechanisms contributing to persistent pulmonary dysfunction following COVID-19 remain unclear. Increased cannabinoid receptor 1 (CBR) expression has been reported in the lungs of patients who died from COVID-19 pneumonia. Multiple studies indicate that CBR overactivation exacerbates inflammation and tissue disrepair in mice, and the level of anandamide (AEA), an endogenous CBR agonist and endocannabinoid, is higher in the lungs of patients with pulmonary fibrosis, correlating with poor lung function. These observations suggest the potential for overactivity of the endocannabinoid/CBR pathway to adversely impact lung repair in COVID-19 pneumonia. METHODS: In this study, we sought to determine the relationship between circulating endocannabinoids and inflammatory mediators in patients with COVID-19 pneumonia from two independent cohorts in different geographic US locations. Endocannabinoid levels were measured using liquid chromatography coupled triple quadrupole mass spectrometry, while inflammatory cytokines and chemokines were measured using Luminex assay in blood serum collected at various time points during COVID-19 pneumonia. RESULTS: We found that blood serum levels of endocannabinoid AEA were significantly elevated in acute COVID-19 pneumonia patients compared to patients with non-COVID-19-associated acute respiratory failure, and healthy controls. Further, 2-arachidonyl glycerol (2AG)] was significantly elevated in acute COVID-19 pneumonia patients on par with non-COVID acute respiratory failure patients. Levels of circulating AEA and 2AG correlated with multiple inflammatory markers. CONCLUSIONS: Our findings suggest increased circulating endocannabinoid tone may be involved in the pathogenesis of COVID-19 pneumonia during the acute phase of illness.
Pathogenesis and treatments for high altitude pulmonary hypertension: An updated review.
Tan Y, Dai J, Ran B … +3 more , Su Q, Luo F, Chen L
Am J Med Sci · 2025 Sep · PMID 40473208 · Publisher ↗
High altitude pulmonary hypertension (HAPH) is a specific type of pulmonary hypertension, caused by chronic exposure to hypobaric hypoxic environment in highlands. Recently, some important studies regarding the pathogene...
High altitude pulmonary hypertension (HAPH) is a specific type of pulmonary hypertension, caused by chronic exposure to hypobaric hypoxic environment in highlands. Recently, some important studies regarding the pathogenesis and treatments for HAPH have been published. Based on these latest publications, we performed an updated review focusing on the pathogenesis and treatments for HAPH.
Cirrhosis and hyponatremia: A review of pathogenesis, clinical relevance, and management.
Flores J, Maldonado AO, Pena C … +1 more , Nugent K
Am J Med Sci · 2025 Sep · PMID 40473207 · Publisher ↗
This narrative review examines the prognostic significance of sodium levels in cirrhosis. Clinical findings such as ascites typically develop between 5 and 10 years post-diagnosis, often with dysregulated sodium balance....
This narrative review examines the prognostic significance of sodium levels in cirrhosis. Clinical findings such as ascites typically develop between 5 and 10 years post-diagnosis, often with dysregulated sodium balance. About 50 % of cirrhosis patients develop hyponatremia, linked to poor prognosis, necessitating effective assessment and management. Hyponatremia arises from splanchnic vasodilation, causing fluid accumulation and reduced effective arterial volume, which triggers adaptive responses that worsen water retention and sodium imbalance. Ascitic fluid contains significant sodium stores, and its levels closely approximate serum values, suggesting that measuring ascitic sodium during therapeutic paracentesis might reduce the need for serum sampling. Management strategies include fluid restriction, vaptans, and albumin infusions, particularly in patients with acute kidney injury and ascites. Although pleural and peritoneal fluid analyses are routine, sodium levels are usually not measured despite their clinical relevance. This review addresses the pathophysiology, clinical implications, and management of hyponatremia in cirrhosis, focusing on patients with ascites or hepatic hydrothorax.
Endovascular therapy in acute ischemic stroke: A six-year national assessment of utilization and outcomes.
Bahar AR, Bahar Y, Ishaq SM … +5 more , Ziaullah A, Upreti P, Alrayyashi M, Bolaji O, Alraies MC
Am J Med Sci · 2025 Oct · PMID 40473206 · Publisher ↗
BACKGROUNDS: Ischemic stroke is a leading cause of death and disability worldwide. Endovascular treatment (EVT) is recognized as an effective intervention for acute ischemic stroke, but only a small fraction of patients...
BACKGROUNDS: Ischemic stroke is a leading cause of death and disability worldwide. Endovascular treatment (EVT) is recognized as an effective intervention for acute ischemic stroke, but only a small fraction of patients with large vessel occlusion receive it. While EVT adoption has grown in the U.S., data on short- and long-term outcomes remain limited. This study aims to assess trends and in-hospital outcomes of stroke patients undergoing EVT. METHODS: We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database from 2016 to 2021. Adult patients hospitalized with LVO stroke involving the internal carotid or middle cerebral arteries were identified using ICD-10-CM codes and stratified by EVT status. Multivariable logistic regression and propensity score matching were used to adjust for baseline characteristics and evaluate in-hospital outcomes. RESULTS: Among 840,335 hospitalizations with LVO stroke, 103,355 (13.3 %) underwent EVT. In the PSM analysis of matched cohort (n=18,460), EVT was associated with higher in-hospital mortality (10.4 % vs. 5.6 %, p<0.001), intracerebral hemorrhage (18.58 % vs. 9.82 %, p<0.001), periprocedural stroke (0.16 % vs. 0.08 %, p=0.035), cardiac arrest (2.93 % vs. 1.37 %, p<0.001), and major adverse cardiac events (13.10 % vs. 8.08 %, p<0.001), acute kidney injury (15.59 % vs. 14.76 %, p=0.025) and arrhythmias (52.96 % vs. 41.40 %, p<0.001). Seizure incidence was lower in the EVT group (1.87 % vs. 2.58 %, p<0.001). CONCLUSIONS: Despite increased use of EVT, our study revealed that patients undergoing this intervention experienced higher in-hospital mortality and complication rates. These findings underscore the importance of patient selection and the need for further real-world studies to optimize EVT outcomes.
Trends and outcomes of atrial fibrillation patients with thrombocytopenia: Insights from the national inpatient sample.
Younes AM, Mahmoud AK, Kamel I … +2 more , Maraey A, Khalil M
Am J Med Sci · 2025 Oct · PMID 40466862 · Publisher ↗
BACKGROUND: Anticoagulation may be indicated for the management of atrial fibrillation (AF) to mitigate thromboembolic risk. Thrombocytopenia in patients with AF may influence clinical outcomes. This study aims to evalua...
BACKGROUND: Anticoagulation may be indicated for the management of atrial fibrillation (AF) to mitigate thromboembolic risk. Thrombocytopenia in patients with AF may influence clinical outcomes. This study aims to evaluate the impact of thrombocytopenia on inpatient outcomes in AF patients. METHODS: Using the National Inpatient Sample (NIS) (2016-2020), patients with AF were identified using the appropriate ICD-10 codes. Outcomes were compared between patients with and without thrombocytopenia. Logistic and linear regression analyses were performed after adjusting for possible confounders. The primary outcome was all-cause inpatient mortality. Secondary outcomes included trends of thrombocytopenia prevalence and mortality in AF patients, major bleeding, hypovolemic shock, packed red blood cell (pRBC) transfusion, ischemic cerebrovascular accident, length of stay, and total charges. RESULTS: A total of 2,016,244 adult patients with AF were identified with 75,545 (3.8 %) having thrombocytopenia. Thrombocytopenia was associated with increased mortality (adjusted odds ratio [aOR] 2.59, 95 % confidence interval [CI] 2.31-2.89, P < 0.001), major bleeding (aOR 2.15, 95 % CI 1.95-2.37, P < 0.001), hypovolemic shock (aOR 3.44, 95 % CI 2.53-4.66, P < 0.001), pRBC transfusion (aOR 3.43, 95 % CI 3.12-3.76, P < 0.001), length of stay (adjusted mean difference [aMD] 1.60 days, 95 % CI 1.51 - 1.69, P < 0.001), and total charges (aMD $17,895, 95 % CI 16,194-19,595, P < 0.001). CONCLUSIONS: Thrombocytopenia is associated with significantly increased mortality, bleeding complications, and resource utilization in patients with AF. These findings highlight the importance of careful management of AF in this population.
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