American Journal of Medicine最新文献

{"title":"Gouty Facet Arthropathy of The Lumbar Spine.","authors":"Yi Ding, Xiaodong Zhang","doi":"10.1016/j.amjmed.2026.04.027","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.027","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Racism as a Clinical Competence: Robert Wilson, Jr. (1867-1946).","authors":"Charles S Bryan, Mason J Schroeder","doi":"10.1016/j.amjmed.2026.04.030","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.030","url":null,"abstract":"<p><p>Addressing health inequity is now recognized as a clinical competency in medical education. We examined the career and writings of Robert Wilson Jr. (1867-1946), longtime dean of the Medical College of the State of South Carolina during the Jim Crow Era, using primary and secondary sources within the context of systemic and structural racism, particularly in South Carolina. Wilson used public health data to refute the \"Black Extinction Hypothesis\" rooted in social Darwinism. He challenged assumptions of inherent Black susceptibility to tuberculosis, linking disease instead to social determinants of health. He also identified disproportionate mortality from kidney and cardiovascular disease among Black populations, anticipating modern health disparities research. Wilson further acknowledged systemic injustice and implicated structural conditions, including housing, in shaping outcomes. In an era of continuing health inequity and racial health disparities, Wilson applied empirical evidence to reject biological determinism, identify outcomes disparities, and advocate for racial justice.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Beauty of Fragility: Aging, Medicine, and Venus by Jago.","authors":"A Perciaccante, A Coralli","doi":"10.1016/j.amjmed.2026.04.037","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.037","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On a Platform in Chhattisgarh.","authors":"Yogesh S Salphale","doi":"10.1016/j.amjmed.2026.04.035","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.035","url":null,"abstract":"<p><p>None.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcoholic Ping-Pong Gaze.","authors":"Yasuhiro Kano","doi":"10.1016/j.amjmed.2026.04.039","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.039","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of complementary health approaches and research interests among older adults in the COSMOS trial.","authors":"Dennis Muñoz-Vergara, Yan Ma, EunMee Yang, Sarah Jaehwa Park, Wren M Burton, Eunjung Kim, JoAnn E Manson, Gloria Y Yeh, Peter M Wayne, Howard D Sesso","doi":"10.1016/j.amjmed.2026.04.001","DOIUrl":"10.1016/j.amjmed.2026.04.001","url":null,"abstract":"<p><strong>Objective: </strong>We examined the prevalence and patterns of complementary health approaches (CHA) use and interest in CHA research participation among COSMOS older adults.</p><p><strong>Methods: </strong>We conducted cross-sectional analyses of the COSMOS Study 2024 survey that asked participants about their use of and research interest in six CHA categories (manual therapies, mind-body therapies, herbal products, acupuncture, spiritual practices, and cannabis/psychedelics). We compared key baseline sociodemographic, lifestyle, and clinical characteristics between CHA users and non-users overall, and for each CHA category. We used multivariable logistic regression models to estimate the odds of CHA use in the past 12 months and ever in lifetime.</p><p><strong>Results: </strong>Of the 16,144 participants who responded (median age, 77.5 y), 58.8% and 76.4% indicated using CHA at least once in the past 12 months and ever in lifetime, respectively, and 50.4% reported interest in participating in CHA research. The highest prevalence of recent use was observed for spiritual practices (38.6%; 95% CI, 37.8-39.3) and lifetime use for manual therapies (51.9%; 95% CI, 51.2-52.7). A history of falls or depression was linked to higher odds of recent and lifetime CHA use.</p><p><strong>Conclusions: </strong>The high prevalence of selected CHA highlights the need to identify evidence gaps for safety, harm, and public health impact for new focused research studies. Limited generalizability to more diverse and medically underserved populations underscores the need for continued integrative health research.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in High-Sensitivity Troponin I Dynamics Pre and Post Parturition are Phenotype Specific.","authors":"Yaxin Li, He S Yang, Zhengming Chen, Isla Racine, Damien Gruson, Allan S Jaffe, Zhen Zhao","doi":"10.1016/j.amjmed.2026.04.021","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.021","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy, such as including preeclampsia and or gestational hypertension, are major contributors to maternal morbidity and future cardiovascular risk. However, interpretation has heretofore been unstudied.</p><p><strong>Methods: </strong>We evaluated peripartum hs-cTnI dynamics and compared phenotype-specific patterns among preeclampsia, hypertension, and normotensive controls in that retrospective cohort study. Leftover serum or EDTA plasma samples collected within ±48 hours of delivery were analyzed. Mixed-effects linear regression models assessed log10-transformed hs-cTnI concentrations and temporal slopes, adjusting for demographic and obstetric covariates.</p><p><strong>Results: </strong>We included 609 participants (788 samples), comprising 90 preeclampsia, 116 hypertension, and 403 normotensive control patients. Median hs-cTnI concentrations were <2.5 ng/L prior to delivery across all groups and increased significantly after delivery. The greatest post-delivery rise occurred in preeclampsia, followed by hypertension and normotensive controls. In multivariable analyses, hs-cTnI levels were higher in PEC compared with normotensive controls (β=0.266, p<0.001) and hypertension (β=0.160, p=0.011), with hypertension also higher than normotensive controls (β=0.107, p=0.046). Peripartum hs-cTnI slopes were steeper in preeclampsia compared with normotensive controls (β=0.005/h, p=0.013). Slopes did not differ between preeclampsia and hypertension. Increases > 99^th % URL were uncommon and occurred more often in preeclampsia.</p><p><strong>Conclusions: </strong>This study provides a systematic assessment of hs-cTnI trajectories during the immediate peripartum period suggests delivery is a physiologic cardiovascular \"stress test\". Preeclampsia is associated with greater myocardial stress compared with normotensive pregnancies, with hypertension demonstrating intermediate changes. These data indicate that marked increases in hs-cTnI are rare during normal deliveries and deserve additional diagnostic evaluation.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uromodulin as a protein and genetic biomarker for hypertension: a detailed systematic review and meta-analysis.","authors":"Hash Brown Taha, Nandhana Vivek, Samuel Ogunsanya, Timothy Zhang, Haroutyun Joulfayan, Armaun D Rouhi, Fatemah Yacoub, Aleksander Bogoniewski, Brian Havens","doi":"10.1016/j.amjmed.2026.04.015","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.015","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is a major global cause of cardiovascular morbidity and mortality, and improved biomarkers are needed to assess risk, disease progression, and treatment response. Uromodulin reflects tubular health and renal sodium handling and has been linked to hypertension. We performed a systematic review and meta-analysis to evaluate uromodulin as a biomarker for hypertension.</p><p><strong>Methods: </strong>We included human studies evaluating uromodulin protein levels or uromodulin-related genome-wide association study outcomes in relation to hypertension. Continuous outcomes were analyzed using inverse variance weighted random effects models, and publication bias was assessed with Begg, Egger tests and funnel plots.</p><p><strong>Results: </strong>Thirty-five studies met the inclusion criteria. Across diagnostic, prognostic, and predictive biomarker studies, 10,726 individuals with hypertension (3,461 females) and 8,762 (3,605 females). Genome-wide association studies included >450,000 hypertension and >150,000 normotensive Across all analyses, uromodulin did not demonstrate clinically meaningful utility as a biomarker for hypertension or hypertension-related outcomes.</p><p><strong>Conclusion: </strong>Our meta-analysis shows that uromodulin is not a clinically useful protein or genetic biomarker for hypertension or hypertension-related outcomes. However, it may still have potential utility in predicting other cardiovascular outcomes.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic Alert-Based Computerized Decision Support for Detection of Chronic Kidney Disease in Type 2 Diabetes Mellitus: The CKD-DETECT Randomized Trial.","authors":"Samuel Z Goldhaber, Sina Rashedi, Mariana Pfeferman, Hannah Leyva, Bassil Bacare, Romain Chopard, Emily S Robinson, Zhou Lan, Behnood Bikdeli, Gregory Piazza","doi":"10.1016/j.amjmed.2026.04.022","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.022","url":null,"abstract":"<p><strong>Background: </strong>Urine albumin-to-creatinine ratio (UACR) provides a reliable method for chronic kidney disease screening in patients with type 2 diabetes, yet its use remains underutilized.</p><p><strong>Methods: </strong>The CKD-DETECT randomized clinical trial included outpatients ≥18 years with type 2 diabetes without UACR testing in the prior 12 months and no chronic kidney disease. Physicians were randomized to receive either an alert prompting UACR testing or no alert (control). The primary outcome was the proportion of UACR orders within 90 days. The secondary outcome was new chronic kidney disease stage 3-5 diagnoses. Tertiary outcomes were referral to a nephrologist and prescription of chronic kidney disease-related medications, and post-hoc outcomes were UACR ≥10 mg/g and ≥30 mg/g.</p><p><strong>Results: </strong>Overall, 400 patients (mean age 64.7 years; 51.5% female) were included. UACR was ordered in 72 (36.0%) patients in the alert group vs. 23 (11.5%) in the control group (odds ratio [OR] 5.71; 95% confidence interval [CI] 2.58-12.64; P<0.001). New diagnoses of chronic kidney disease occurred in 1 (0.5%) patient in the alert and 2 (1.0%) in the control group (OR 0.50, 95%CI 0.04-5.53; P=0.570). There were no referrals to nephrologists or new prescriptions of chronic kidney disease-related medications. The alert group was associated with increased identification of UACR ≥10 mg/g (21.0% vs. 8.5%; OR 3.41; 95%CI 1.37-8.48; P=0.008) and ≥30 mg/g (9.5% vs. 4.0%; OR 3.71; 95%CI 1.36-10.12; P=0.011).</p><p><strong>Conclusion: </strong>The alert-based CDS program was associated with increased UACR testing and early detection of elevated albuminuria in patients with diabetes.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov identifier, NCT05342545 (prospectively registered on April 18, 2022) FUNDING: : This work was supported by a research grant from Bayer.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internal Medicine Residents' Perceptions of Autonomy and Supervision across Clinical Training Sites: A Multicenter Study.","authors":"David E Rink, Gabrielle Berger, Galant Chan, LeeAnn M Cox, Megha Garg, Hussain R Khawaja, Brian Kwan, Julia Limes, Rosechelle Ruggiero, Noelle C Sinex, Tyler J Albert","doi":"10.1016/j.amjmed.2026.04.012","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.04.012","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}