Mayo Clinic proceedings最新文献

{"title":"Laboratory Artifacts in Clinical Medicine: A Review","authors":"Zahir Kanjee MD, MPH,&nbsp;Giuseppe Lippi MD,&nbsp;Jason A. Freed MD","doi":"10.1016/j.mayocp.2026.04.009","DOIUrl":"10.1016/j.mayocp.2026.04.009","url":null,"abstract":"<div><div>Laboratory artifacts—spurious or incorrect results—harm patients when they lead to inaccurate diagnosis and inappropriate clinical management. Although artifacts can seem random, many are explicable with knowledge of laboratory test mechanism and physiology. In this review for the practicing clinician, we illustrate this point using 4 of the most common tests in hospitalized patients—serum chemistry, complete blood count, coagulation testing, and urine drug screening—and the most frequent artifacts they report. We searched the PubMed database for articles before March 21, 2025, supplementing with personal libraries and references of selected articles, choosing topics based on clinical relevance. Pseudohyperkalemia can be due to release of intracellular potassium such as in in vitro hemolysis, leukocytosis, thrombocytosis, imperfect phlebotomy technique, delayed sample transport, and contamination by additives. Pseudothrombocytopenia can be due to EDTA-induced platelet clumping. Unexpectedly low platelet counts should be verified with manual smear and retested with an alternative anticoagulant when clumping is present. Artificially prolonged coagulation assays can be seen when drawing through a line previously instilled with heparin or from a vein proximal to anticoagulant infusion and in underfilled blood tubes. When an unexpectedly prolonged coagulation assay is encountered, direct venipuncture of the arm contralateral to the anticoagulant infusion with a fully filled tube will eliminate most sources of error. Most screening urine drug tests are immunoassays and susceptible to artifact. False positives can occur in immunoassays detecting similar but nonidentical molecules or shared metabolites from another drug; false negatives can be caused by rapid elimination of certain drugs and through intentional urine adulteration. We demonstrate the importance of knowledge of test physiology and mechanism to interpreting an unexpected result, an approach that will enable clinicians to prevent, recognize, and mitigate laboratory artifacts not only for these tests but also for many others.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Pages 1818-1836"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Mortality Related to Idiopathic Inflammatory Myopathies in the United States, 1999-2024","authors":"Jiaqian Zhang MD,&nbsp;Jun Qiao PhD,&nbsp;Maoning Wang BMed,&nbsp;Jingyu Yang BMed,&nbsp;Geng Yin MD,&nbsp;Qibing Xie MD","doi":"10.1016/j.mayocp.2026.07.020","DOIUrl":"10.1016/j.mayocp.2026.07.020","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Pages 1875-1878"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Obesity Paradox and Cancer-Associated Venous Thromboembolism","authors":"Robert D. McBane II MD","doi":"10.1016/j.mayocp.2026.08.009","DOIUrl":"10.1016/j.mayocp.2026.08.009","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Pages 1670-1672"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytokeratin-Expressing Plasma Cell Myeloma","authors":"Jennifer L. Herrick MD","doi":"10.1016/j.mayocp.2026.06.026","DOIUrl":"10.1016/j.mayocp.2026.06.026","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Pages 1676-1677"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Infective Hepatic Artery Aneurysm","authors":"Romina Vergara-Quispe MD,&nbsp;Jordi Brull MD,&nbsp;Paula Escarcena MD","doi":"10.1016/j.mayocp.2026.07.027","DOIUrl":"10.1016/j.mayocp.2026.07.027","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Pages 1778-1779"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"40-Year-Old Man With Chest Pain and Diaphoresis","authors":"Taylor P. Kennedy MD,&nbsp;Mohamed G. Ibrahim DO,&nbsp;Prajwal Reddy MD","doi":"10.1016/j.mayocp.2025.10.023","DOIUrl":"10.1016/j.mayocp.2025.10.023","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Pages 1850-1854"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embedding Ethics Into Decision-Making Capacity Assessment: An Electronic Health Record–Enabled Systemwide Approach","authors":"Cynthia M.A. Geppert MD, PhD, DPS, MPH, MA, MSJ,&nbsp;Joleen C. Sussman PhD,&nbsp;Hannah N. Hester LCSW,&nbsp;Anita J. Tarzian PhD, RN","doi":"10.1016/j.mayocp.2026.07.004","DOIUrl":"10.1016/j.mayocp.2026.07.004","url":null,"abstract":"<div><div>Decision-making capacity (DMC) assessments are essential for ensuring patients' autonomy and welfare in health care. Existing literature rarely addresses how to integrate ethics into DMC assessment. To address this gap, we present a practical, ethically grounded framework for clinical DMC assessment, informed by 5 key considerations (who, when, where, how, and why), supported by a templated electronic health record progress note and embedded cues and training resources for system-wide implementation. We address ethical imperatives such as obtaining consent for DMC assessments, managing patient participation, and ensuring assessments are done by the practitioner responsible for the medical decision at hand when clinically indicated, always aiming to maximize the patient's ability to demonstrate capacity.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Pages 1780-1787"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Rates of Hip Fractures Associated With Longer Spaceflight Durations","authors":"Tristen N. Taylor MD,&nbsp;Millennia Young PhD,&nbsp;Elisabeth R. Spector BS,&nbsp;Amy Kreykes MD,&nbsp;Jean D. Sibonga PhD","doi":"10.1016/j.mayocp.2026.06.025","DOIUrl":"10.1016/j.mayocp.2026.06.025","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze a recent survey of all astronaut fractures to assess whether the rate of postflight fractures is associated with durations of spaceflight missions.</div></div><div><h3>Methods</h3><div>Follow-up group comparisons of fracture incidence data (surveyed between 2018 and 2022) were analyzed within the astronaut cohort. Analyzing within the astronaut cohort addressed biases associated with the perception of greater physical activity in astronauts as a discriminating risk factor for fractures. The number of fractures was modeled using count regression adjusting for (1) repeated measures within individuals across the follow-up groups, (2) differing lengths of surveillance for each individual, and (3) average age for members of the follow-up groups.</div></div><div><h3>Results</h3><div>Analysis of hip fractures revealed an increased rate of hip fractures during the surveillance period after exposure to a long-duration spaceflight (LD-SF) vs non–LD-SF [posterior probability (relative rate &gt;1)] = 0.9929; Bayes factor [where &gt;3 is considered significant] = 140) or no spaceflight (posterior probability [relative rate &gt;1] = 0.9988; Bayes factor = 832). Compared with terrestrial hip fracture rates, fracture rates in the LD-SF timeframe were similar to non-astronaut persons who were 8 to 16.5 years older (mean age 62.5 vs 70 to 79-year-old persons). For all other skeletal sites, rates of fracture were similar for long-duration (LD) and non-LD exposures.</div></div><div><h3>Conclusion</h3><div>This analysis is the first to report an increased hip fracture rate in astronauts (1) at an earlier age than in non-astronauts and (2) with astronaut fracture surveillance conducted during the period following an LD-SF mission (greater than 90 days) rather than during the period before or with no exposure to long-duration mission.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Pages 1700-1711"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inspiration by Alicia Armstrong","authors":"Margaret R. Wentz BA","doi":"10.1016/j.mayocp.2026.08.004","DOIUrl":"10.1016/j.mayocp.2026.08.004","url":null,"abstract":"<div><div>Art is integrated into the Mayo Clinic environment. Since the original Mayo Clinic Building was finished in 1914, many pieces have been donated or commissioned for patients and staff to enjoy. Each issue of <em>Mayo Clinic Proceedings</em> features a work of art (as interpreted by the author) that is displayed in a building or on the grounds of Mayo Clinic campuses.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Page 1895"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights from the Current Issue – Audiovisual Summary","authors":"Karl A. Nath MBChB","doi":"10.1016/j.mayocp.2026.09.007","DOIUrl":"10.1016/j.mayocp.2026.09.007","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 10","pages":"Page e1"},"PeriodicalIF":6.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}