American Journal of Medicine最新文献

{"title":"Macaroni Sign: Point-of-Care Ultrasound Identification of Takayasu Arteritis.","authors":"Eric Zhang, Jennifer Smiechowski, Emma E M Spence, Stefana Pancic, Irene W Y Ma","doi":"10.1016/j.amjmed.2025.06.008","DOIUrl":"10.1016/j.amjmed.2025.06.008","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286960","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":"Hepatitis C Virus Associated Cryoglobulinemic Vasculitis.","authors":"Benjamin Y Hsieh, Mohamed Ismail, Menna-Allah Elaskandrany","doi":"10.1016/j.amjmed.2025.05.051","DOIUrl":"10.1016/j.amjmed.2025.05.051","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286957","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":"Correlates of Polypharmacy and Prescription Changes in Internal Medicine: a Prospective Five-Year Study.","authors":"Marco Vincenzo Lenti, Carmine Frenna, Alice Silvia Brera, Antonio Di Sabatino, Catherine Klersy, Gino Roberto Corazza","doi":"10.1016/j.amjmed.2025.06.012","DOIUrl":"10.1016/j.amjmed.2025.06.012","url":null,"abstract":"<p><strong>Background: </strong>Data regarding polypharmacy in the internal medicine setting remain limited. We aimed to assess the prevalence of polypharmacy, examine its associations with clinical and socioeconomic factors, and evaluate its impact on mortality.</p><p><strong>Methods: </strong>This was part of the San MAtteo Complexity (SMAC) study (2017-2025), conducted in an internal medicine service of an academic medical center. Patients were consecutively and prospectively enrolled. Polypharmacy prevalence was assessed at admission and discharge. Sociodemographic data, Cumulative Illness Rating Scale (CIRS), Edmonton Frail Scale, comorbidity, multimorbidity, Short Blessed Test, and Barthel Index were collected. Associations with polypharmacy were analyzed using logistic regression, and early and late mortality were tracked using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Among 1419 patients (median age 80 years, IQR 69-86; F:M ratio 1.14:1), polypharmacy was observed in 71.5 % at admission and 82.6 % at discharge. Patients with polypharmacy were significantly older, frailer, and had lower socioeconomic status. Independent predictors included age ≥65 years (OR 4.14, 95 % CI 1.60-10.69), CIRS >3 (OR 2.67, 95 % CI 1.98-3.58), frailty (OR 3.85, 95 % CI 0.68-1.50), comorbidity (OR 8.2, 95 % CI 2.19-30.7), multimorbidity (OR 20.91, 95 % CI 5.65-77.44), and cardiovascular disorders (OR 1.84, 95 % CI 1.33-2.55). In-hospital and 4-month mortality were significantly higher among patients who were deprescribed (i.e., discharged with ≤5 fewer medications). Five-year mortality was significantly higher in patients with polypharmacy (HR 2.83, 95 % CI 2.07-3.86; P<0.001), regardless of prescription changes.</p><p><strong>Conclusions: </strong>Polypharmacy is highly prevalent in internal medicine, and both deprescribing and polypharmacy are associated with increased mortality at different timepoints, underscoring the need for targeted medication optimization strategies.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295282","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":"Recent Advances in Diagnosis and Treatment of Prostate Cancer.","authors":"Edward J Goetzl, Samuel L Washington","doi":"10.1016/j.amjmed.2025.06.002","DOIUrl":"10.1016/j.amjmed.2025.06.002","url":null,"abstract":"<p><p>The incidence of metastatic prostate cancer (mPC) in the U.S. has increased in the past 20 years, five-year survival after diagnosis is only about 20 % and treatment represents a major health care expense. Comprehensive summaries of important details of diagnosis and treatment of prostate cancer (PC) have been provided by several prominent medical organizations (http://www.urologyhealth.org). The present review summarizes recent advances in diagnosis and treatment of PC, including ⁶⁸gallium-prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET) as the preferred standard for initial staging and post-treatment detection of recurrence, different forms of radiation therapy, and applications of newly approved androgen receptor signaling inhibitors. Somatic and germline genetic analyses have identified PC patients with mutations in genes involved in DNA damage repair who benefit from use of poly (ADP-ribose) polymerase (PARP) inhibitors or immune check-point inhibitors. Developing novel therapies also are described as hopeful possibilities.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295284","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":"Extended Thromboprophylaxis in Patients Hospitalized with COVID-19 at Time of Discharge is Not Associated with Improvement in Quality of Life.","authors":"Lana Wahid, Taeim Kwon, Lisa Baumann Kreuziger, Raj S Kasthuri, Peter J Miller, Tracy Y Wang, Kevin J Anstrom, Thomas L Ortel","doi":"10.1016/j.amjmed.2025.06.003","DOIUrl":"10.1016/j.amjmed.2025.06.003","url":null,"abstract":"<p><strong>Background: </strong>The long-term effects of COVID-19, known as post-acute sequelae of SARS-CoV-2 infection (PASC), impair quality of life (QoL). This secondary analysis of the ACTIV-4c clinical trial evaluates the specific effects of extended thromboprophylaxis with apixaban on individual QoL domains, assessed by EQ-5D-5L index, in patients discharged after COVID-19 hospitalization.</p><p><strong>Methods: </strong>ACTIV-4c study was a prospective randomized, placebo-controlled, double-blind clinical trial. We enrolled 1,217 patients hospitalized with COVID-19 at 107 U.S. hospitals between February 2021 and June 2022. Participants were randomized to apixaban 2.5 mg twice daily or placebo for 30 days post-discharge. QoL was assessed using EQ-5D-5L index at 2, 30, and 90 days post-discharge, evaluating five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Data were analyzed using chi-square tests and proportional odds models adjusted for multiple variables.</p><p><strong>Results: </strong>Of 1,217 participants, 610 received apixaban and 607 received placebo. By 2 days post-discharge, 43.5% of apixaban and 45.0% of placebo recipients reported moderate impairment in one or more EQ-5D-5L domains, particularly usual activities (33.0%). At 30 days, moderate impairment persisted in 30.8% of apixaban and 33.4% of placebo recipients, improving most in the usual activities domain (17.4%). At 90 days, 31.5% of apixaban and 28.5% of placebo recipients reported moderate impairment. Extended thromboprophylaxis with apixaban was not associated with significant improvements in any EQ-5D-5L domains at 30 or 90 days.</p><p><strong>Conclusions: </strong>Extended thromboprophylaxis with apixaban after COVID-19 hospitalization does not improve QoL. The high prevalence of QoL impairment highlights the need for targeted interventions for PASC.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295283","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 Residency Point-of-Care Ultrasound (POCUS) Consensus Recommendations for Core Indications and Applications.","authors":"Charles M LoPresti, Kevin J Murray, Ria Dancel, Cameron Baston, Brandon Boesch, David Brennan, Apostolos P Dallas, Renee Dversdal, Timothy Flynn, Ricardo A Franco Sadud, Trevor P Jensen, Benji K Mathews, Nilam J Soni, Kang Zhang, David M Tierney","doi":"10.1016/j.amjmed.2025.05.033","DOIUrl":"10.1016/j.amjmed.2025.05.033","url":null,"abstract":"<p><strong>Background: </strong>Bedside point-of-care ultrasound (POCUS) is quickly becoming a routine part of internal medicine practice and training. The optimal POCUS training venue for internists is at the graduate medical education or residency stage of their career. Despite increased training, clinical use, and broad internal medicine society endorsement in the United States, no internal medicine POCUS consensus curricula exist. The goal of this consensus process was to guide the core elements for inclusion within internal medicine residency POCUS curricula in the United States.</p><p><strong>Methods: </strong>A 4-step modified Delphi methodology was used to establish consensus (75% agreement) recommendations for core indications and applications among a panel of 14 inpatient- and outpatient-based, residency-affiliated, internal medicine POCUS experts in the United States.</p><p><strong>Results: </strong>The consensus process identified 12 core diagnostic and 6 procedural POCUS indications (eg, dyspnea, shock, chest pain, thoracentesis, etc.), with an associated 15 diagnostic POCUS applications (eg, focused cardiac, gallbladder, urinary bladder, etc.) and 52 specific skill components (eg, identification of pericardial effusion, cholelithiasis, bladder volume, etc.) that reached consensus for inclusion in core curricula.</p><p><strong>Conclusions: </strong>This consensus process represents the first expert and evidence-based recommendation for what POCUS elements should fall into a core internal medicine residency-based curriculum in the United States. Many areas not meeting consensus for inclusion still fall within the broader internal medicine POCUS scope and can be clinically impactful for specific subgroups of internists, such as advanced internal medicine POCUS users, and specific inpatient and outpatient clinical environments.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286958","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":"A Decade of Hypnotherapy Research for Multiple Sclerosis Symptom Management: A Systematic Review.","authors":"Ahmet Onat Özdemir, Mauro Cozzolino, Osman Gürdal, Ivonne Carosi Arcangeli, Stefania Mancone, Giovanna Celia","doi":"10.1016/j.amjmed.2025.05.049","DOIUrl":"10.1016/j.amjmed.2025.05.049","url":null,"abstract":"<p><p>This systematic review investigates the effectiveness of hypnotherapy for symptom control in multiple sclerosis (MS) patients. Following PRISMA guidelines, eight research participants (N=423, sample sizes 15-173) were assessed using the PEDro scale. Hypnotherapy showed significant benefits, including a 30-45% reduction in pain intensity (p<0.01), an 8.19 point decrease in Multidimensional Fatigue Inventory scores (p<0.05), a 1.98-point improvement in Pittsburgh Sleep Quality Index scores (P<0.05), and a 3.7-point reduction in DASS-21 depression subscale. Optimal protocols included 8-10 weekly 45-60-minute sessions, with coupled treatments (hypnotherapy with neurofeedback or mindfulness) producing better results (additional 15-20% improvement). Follow-ups revealed that psychological advantages persisted, although pain alleviation decreased after 6 months without maintenance. The evidence suggests that hypnotherapy can be an effective additional strategy for MS symptom management, with hypnotic cognitive treatment exhibiting notable efficacy for tiredness and psychosocial problems. Methodological limitations demand larger trials with standardized methodologies.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286956","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":"An Integrative Approach to HPA Axis Dysfunction: From Recognition to Recovery.","authors":"Melinda Ring","doi":"10.1016/j.amjmed.2025.05.044","DOIUrl":"10.1016/j.amjmed.2025.05.044","url":null,"abstract":"<p><strong>Objectives: </strong>The hypothalamic-pituitary-adrenal (HPA) axis plays a central role in the body's stress response and is increasingly recognized as a contributor to a range of chronic health conditions. This review aims to provide an evidence-based overview of HPA axis dysregulation, including its underlying mechanisms, diagnostic approaches, and integrative treatment strategies.</p><p><strong>Methods: </strong>A comprehensive review of peer-reviewed literature was conducted to examine the multifactorial contributors to HPA axis dysfunction. Sources included studies on psychological stress, dietary and lifestyle factors, genetic and epigenetic influences, immune system interactions, gut health, inflammation, environmental toxins, and hormonal imbalances. Diagnostic modalities such as serum and salivary cortisol testing were also reviewed.</p><p><strong>Results: </strong>HPA axis dysfunction is influenced by a complex interplay of internal and external stressors, including chronic psychological stress, dietary imbalances, disrupted circadian rhythms, and environmental exposures. Diagnostic methods vary in sensitivity and clinical utility, with diurnal salivary cortisol profiles offering insight into functional patterns. Integrative treatment approaches include patient-centered care, mind-body therapies, dietary and lifestyle interventions, targeted nutraceuticals, and adaptogenic herbs-each aimed at restoring balance and improving stress resilience.</p><p><strong>Conclusions: </strong>Understanding HPA axis dysregulation through an integrative lens supports a more individualized and comprehensive approach to care. By bridging conventional endocrinology and functional medicine, clinicians are better equipped to address commonly overlooked symptoms such as fatigue, insomnia, mood disturbances, and poor stress tolerance, ultimately enhancing patient outcomes.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276539","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":"Elevated Lipoprotein(a): A Treatment Challenge and a Practical Solution.","authors":"David S Schade, Allen Adolphe, Samuel Wann, Robert Philip Eaton","doi":"10.1016/j.amjmed.2025.05.035","DOIUrl":"10.1016/j.amjmed.2025.05.035","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250598","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":"Impact of Dual Antiplatelet Therapy Duration on Long-Term Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention.","authors":"Yao Jiang, Han Zhang, Chujie Zhang, Yingyang Geng, Yin Zhang, Changdong Guan, Kefei Dou, Yuejin Yang, Shubin Qiao, Yongjian Wu, Lei Song","doi":"10.1016/j.amjmed.2025.05.038","DOIUrl":"10.1016/j.amjmed.2025.05.038","url":null,"abstract":"<p><strong>Background: </strong>Optimal dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention for coronary chronic total occlusion remains unclear. Thus, we aim to determine the optimal DAPT duration in this high-risk cohort with complex anatomy and procedures.</p><p><strong>Methods: </strong>Between January 2010 and December 2013, 2659 consecutive chronic total occlusion patients undergoing percutaneous coronary intervention at Fuwai Hospital were enrolled, and those without adverse events within 12 months were categorized into long-term (>12 months) or short-term (≤12 months) groups according to DAPT duration. The primary endpoint was a composite of cardiac deaths and spontaneous myocardial infarction at 5 years. The safety endpoint was the rate of Bleeding Academic Research Consortium (BARC) 2, 3, or 5 type bleeding at 5 years.</p><p><strong>Results: </strong>Overall, 1923 patients were included in the final analysis, of which 1104 (57.4 %) continued DAPT beyond 12 months. Compared with short-term DAPT, long-term DAPT was associated with a lower rate of primary outcome (3.6 % vs 6.3 %; adjusted hazard ratio [aHR] 0.58; 95 % confidence interval [CI], 0.38-0.89, P = .01), primarily driven by fewer cardiac death (0.1 % vs 4.0 %, aHR 0.02; 95 % CI, 0.00-0.17; P < .001) and a higher risk of BARC 2-5 bleeding (3.8 % vs 1.5 %; aHR 2.61; 95 % CI, 1.37 to 4.97, P < .01), whereas the risk of BARC 3 or greater was comparable between groups.</p><p><strong>Conclusion: </strong>In patients undergoing chronic total occlusion percutaneous coronary intervention, prolonged DAPT was associated with a reduced risk of cardiac death and myocardial infarction, but with an increased risk of minor bleeding.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250599","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}