American Journal of Medicine最新文献

{"title":"The Need for a Functional Class 0 in Heart Failure.","authors":"Daniel M Gelfman","doi":"10.1016/j.amjmed.2025.05.013","DOIUrl":"10.1016/j.amjmed.2025.05.013","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129355","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":"Troponin Tests in Patients Admitted to Internal Medicine Departments Without an Acute Coronary Syndrome-Less Is More.","authors":"Paul Froom, Jonathan Lellouche, Zvi Shimoni","doi":"10.1016/j.amjmed.2025.05.022","DOIUrl":"10.1016/j.amjmed.2025.05.022","url":null,"abstract":"<p><strong>Introduction: </strong>The study aimed to determine the frequency and factors associated with elevated troponin test results and whether an elevated test result provides an independent incremental increase in in-hospital mortality and affects patient care.</p><p><strong>Methods: </strong>We selected consecutive patients admitted to 3 internal medicine departments in a regional hospital in 2020-2021 after excluding those with chest pain or ischemic electrocardiographic changes. The outcome variables were in-hospital mortality, elevated troponin test results, repeat testing, and changes in patient care. Other variables included male sex, age, nursing patient assessments, laboratory tests, and discharge diagnosis.</p><p><strong>Results: </strong>There were 10,483 patients aged 73 ± 19 years, 51.1% (n = 5359) were female, and troponin was ordered in 16.2%. Elevated values above the reference range (>14 ng/L), ≥20 ng/L, and ≥50 ng/L were found in 70.6% (1247/1767), 56.1% (n = 992) and 22.4% (n = 396), respectively. Older age, male sex, poor nutritional and mental status, being bedridden, and abnormal basic laboratory tests predicted troponin values of ≥50 ng/L with a c-statistic of 0.857 (0.833-0.867). In the model predicting in-hospital mortality, adding an elevated troponin test did not significantly change the deciles of risk or c-statistics (0.89 and 0.91, respectively). Elevated troponin test values were associated with repeat testing and cardiology consultations. Three patients had coronary arteriograms without a percutaneous coronary intervention.</p><p><strong>Conclusion: </strong>In patients hospitalized without chest pain or ischemic electrocardiographic changes, elevated troponin tests are common, do not provide an incremental increase in in-hospital mortality risk, and negatively affect patient care.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129374","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":"Serum Vitamin D Levels and Long-Term Risk of Elderly-Onset Inflammatory Bowel Disease: A Large-Scale Prospective Cohort Study.","authors":"Qian Zhang, Si Liu, Shengtao Zhu, Aifang Li, Xiujing Sun, Shanshan Wu, Shutian Zhang","doi":"10.1016/j.amjmed.2025.05.017","DOIUrl":"10.1016/j.amjmed.2025.05.017","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D is considered as a potential immunomodulator in inflammatory bowel disease development; however, emerging evidence remains inconsistent. We aimed to investigate the prospective association between serum vitamin D level and long-term risk of elderly-onset inflammatory bowel disease in a large-scale cohort.</p><p><strong>Methods: </strong>Participants without inflammatory bowel disease at enrollment from the UK Biobank were included. Baseline blood samples were collected and serum 25-hydroxyvitamin D (25[OH]D) levels were measured. Participants were classified as having vitamin D deficiency (< 50 nmol/L), insufficiency (50-75 nmol/L) or sufficiency (≥ 75 nmol/L) based on predefined cutoffs. Primary outcome was incident elderly-onset inflammatory bowel disease, including ulcerative colitis and Crohn disease. Hazard ratio (HR) and 95% confidence intervals (CIs) of related associations were determined using multivariable Cox regression.</p><p><strong>Results: </strong>Among 357,656 participants (mean age, 57.9±6.9 years), 196,499 (54.9%) and 121,035 (33.8%) had vitamin D deficiency and insufficiency, respectively. During a median 13.3 years follow-up, 1622 elderly-onset inflammatory bowel disease cases were identified. Compared with vitamin D sufficiency, no associations with vitamin D deficiency (HR = 0.91; 95% CI, 0.78-1.07) or insufficiency (HR = 0.86; 95% CI, 0.73-1.01) were observed for elderly-onset inflammatory bowel disease. Similarly, no associations with per 10 nmol/L increase of serum 25(OH)D were detected for elderly-onset inflammatory bowel disease (HR = 1.00; 95% CI, 0.98-1.03), ulcerative colitis (HR = 1.00; 95% CI, 0.97-1.03), or Crohn disease (HR = 1.01; 95% CI, 0.97-1.05). Compared with the lowest quartile, no associations with higher quartiles of serum 25(OH)D were observed for inflammatory bowel disease (HR_Q4VSQ1 = 1.03; 95% CI, 0.89-1.19), ulcerative colitis (HR_Q4VSQ1 = 1.06; 95% CI, 0.90-1.26), or Crohn disease (HR_Q4VSQ1 = 0.93; 95% CI, 0.73-1.20). Further sensitivity and subgroup analyses demonstrated similar results.</p><p><strong>Conclusions: </strong>Serum vitamin D level or deficiency status is not associated with the development of elderly-onset inflammatory bowel disease, ulcerative colitis, or Crohn disease.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121454","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":"Promotion Support for Women in Medicine (PSWIM) Initiative: An Innovative Approach.","authors":"Neha Mittal, Rakhee K Bhayani, Jillian S Catalanotti, Shobhina G Chheda, Susan T Hingle, Danielle Jones, Margaret C Lo, Lauren A Peccoralo, Karen A Friedman","doi":"10.1016/j.amjmed.2025.05.023","DOIUrl":"10.1016/j.amjmed.2025.05.023","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112650","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 Forcing Factors of Physical Inactivity and Obesity in the United States - An Artificial Intelligence Analysis of an Ecological Framework.","authors":"Ross Arena, Shuaijie Wang, Nicolaas P Pronk, Colin Woodard, Tanvi Bhatt","doi":"10.1016/j.amjmed.2025.05.011","DOIUrl":"10.1016/j.amjmed.2025.05.011","url":null,"abstract":"<p><strong>Background: </strong>A sedentary lifestyle and obesity are primary factors forcing the ongoing chronic disease health crisis in the United States. The aim of the current study is to assess whether an ecological framework can predict United States physical inactivity and obesity prevalence using an artificial intelligence model.</p><p><strong>Methods: </strong>The current study utilized several United States county-level datasets representing 12 predictive variables of the ecologic framework. A nonlinear artificial intelligence statistical approach was used to assess the ability of these variables (i.e, features) to predict United States county-level physical inactivity and obesity.</p><p><strong>Results: </strong>The R² values demonstrated that the performance of Extra Trees models was different across the 2 outcomes. While models for both physical inactivity and obesity prediction were significant, physical inactivity always exhibited the higher R² for each feature number (6-12) compared with obesity. These models' performance was also influenced by the number of features. An increase in the number of features led generally to improved model performance. For physical inactivity, the highest R² and lowest AIC was achieved using all 12 features, hence, the 12-feature model was identified as the optimal model for physical inactivity prediction. For obesity, the highest R² and lowest AIC was achieved using 10 features.</p><p><strong>Conclusion: </strong>These results further support validity of the proposed ecological framework, including culture, politics, policy, and social, physical, and economic environment factors in explaining variability in United States physical inactivity and obesity prevalence.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112659","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":"Unilateral Osler Nodes and Janeway Lesions: Look Beyond the Heart.","authors":"Nils Bürgisser, Jérémy Cendan, Christian Hulo, Angela Huttner, Jacques Serratrice","doi":"10.1016/j.amjmed.2025.05.019","DOIUrl":"10.1016/j.amjmed.2025.05.019","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112663","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":"Consumption of Fruit Juice and Risk of Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.","authors":"Chung-Woo Lee, Seung-Kwon Myung","doi":"10.1016/j.amjmed.2025.05.021","DOIUrl":"10.1016/j.amjmed.2025.05.021","url":null,"abstract":"<p><strong>Background: </strong>Previous observational studies on the association between the consumption of fruit juice and the risk of type 2 diabetes mellitus have reported inconsistent findings. We investigated the association using a meta-analysis of prospective cohort studies.</p><p><strong>Methods: </strong>Studies were identified through PubMed and EMBASE searches from inception to August 3, 2024. We calculated pooled relative risks (RRs) and 95% confidence intervals (CIs). The consumption of fruit juice was categorized into 100% fruit juice and non-100% fruit juice. The primary outcome was the incidence of type 2 diabetes mellitus.</p><p><strong>Results: </strong>Out of 1591 articles, 14 prospective cohort studies were included in the final analysis. In the meta-analysis of all studies, there was no significant association between the consumption of overall fruit juice and the risk of type 2 diabetes mellitus (RR, 1.06 [95% CI, 0.98-1.15], P = .170). In the subgroup meta-analysis by juice type, non-100% fruit juice was statistically significantly associated with an increased risk of type 2 diabetes mellitus (RR, 1.15 [95% CI, 1.03-1.28], P = .012), while there was no significant association between the consumption of 100% fruit juice and the risk of type 2 diabetes mellitus. An increased risk of type 2 diabetes mellitus by fruit juice was observed only in Asian populations (RR, 1.17 [95% CI 1.02-1.34], P = .023).</p><p><strong>Conclusion: </strong>The consumption of non-100% fruit juice increased the risk of type 2 diabetes mellitus. Unlike whole fruit consumption, 100% fruit juice had no beneficial effect on the risk of type 2 diabetes mellitus.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112644","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":"Lack of Change in the Incidence of Unstable Angina after Transition to High-Sensitivity Cardiac Troponin T.","authors":"Olatunde Ola, Jonathan D Knott, Laura De Michieli, Ronstan Lobo, Joshua Slusser, Ashok Akula, Marshall Dworak, Tahir Tak, Charles Cagin, Yader Sandoval, Allan S Jaffe","doi":"10.1016/j.amjmed.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.010","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the impact of high-sensitivity cardiac troponin T (hs-cTnT) implementation on the incidence and cardiac evaluations of patients with unstable angina.</p><p><strong>Methods: </strong>Retrospective US cohort study of emergency department patients evaluated with troponin (cTn) measurements transition from 4th generation cTnT (6 months pre-implementation) to 5th generation hs-cTnT assay (6 months post-implementation).</p><p><strong>Results: </strong>Only 39 patients were diagnosed with unstable angina; 18 with 4th cTnT and 21 with 5th hs-cTnT. With 4th generation cTnT assay almost all (94.4%) had values < 99th URL whereas 33.3% had at least one value > 99th (mean = 25ng/L and peak = 26 ng/L) with hs-cTnT. The latter had underlying structural heart disease. There were no significant differences in cardiac evaluations with echocardiography, stress testing or invasive coronary angiography (between groups.</p><p><strong>Conclusions: </strong>The incidence of unstable angina did not change with transition to 5th generation hs-cTnT assay. However, stable hs-cTnT increases were more common likely due to underlying structural heart disease. There were no changes in frequency of cardiac evaluations.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112647","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":"Right Coronary Artery Ulcerated Atheromatous Plaque.","authors":"Leizhi Ku, Qing Yan, Wenjun Deng, Xiaojing Ma","doi":"10.1016/j.amjmed.2025.04.021","DOIUrl":"10.1016/j.amjmed.2025.04.021","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112652","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":"Biosocial Variation in Treatment Response to GLP-1s: Implications for Clinical Care and Health Policy.","authors":"Ralph I Horwitz, Sydney Nur Otaka, Allison Hayes Conroy, Mark R Cullen, Adú Matory, Burton H Singer, Ida Sim","doi":"10.1016/j.amjmed.2025.05.016","DOIUrl":"10.1016/j.amjmed.2025.05.016","url":null,"abstract":"<p><p>The potential of GLP-1s to change the trajectory of obesity has ignited enthusiasm for these drugs among physicians, patients, and policymakers. The \"average\" reported weight loss of 20%-25% of body weight has become reified as the \"expected\" benefit for patients with previously treatment-resistant obesity. In our article, we demonstrate the considerable variation around the average treatment response observed in randomized controlled trials, illustrate that the variation is even more pronounced in real-world evidence studies, and examine the role of \"biosocial pathogenesis\" as a possible explanation for the variation. Biosocial pathogenesis examines the role of both biology and biography on physiological systems that affect both the risk for disease and the response to treatment. Research is needed that enables clinical management to be tailored to the biology and \"biography\" of patients with obesity and obesity-related disorders.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112640","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}