Journal of Internal Medicine最新文献

{"title":"Excess risk of bleeding in patients with venous thromboembolism on direct oral anticoagulants during initial and extended treatment versus population controls.","authors":"Katarina Glise Sandblad, Annika Rosengren, Sam Schulman, Maria Roupe, Tatiana Zverkova Sandström, Jacob Philipson, Kristina Svennerholm, Mazdak Tavoly","doi":"10.1111/joim.20067","DOIUrl":"https://doi.org/10.1111/joim.20067","url":null,"abstract":"<p><strong>Background: </strong>The risk of major bleeding from anticoagulant treatment is influenced by both the treatment and the patient's baseline risk, which is often disregarded.</p><p><strong>Objectives: </strong>To determine the excess bleeding risk in venous thromboembolism (VTE) cases during initial (0 to 6 months) and extended (6 months to 5 years) treatment compared to matched population controls without VTE or anticoagulant treatment, overall, and stratified by sex and age.</p><p><strong>Methods: </strong>Cancer-free patients with VTE treated with direct oral anticoagulants from 2014 to 2020, along with propensity score-matched controls, were identified from nationwide Swedish registers. Excess risk of major bleeding was assessed using the incidence rate difference (IRD) calculated by subtracting the control bleeding rate from the case bleeding rate.</p><p><strong>Results: </strong>The matched cohort comprised 36,115 VTE cases and 36,115 controls. During initial treatment, 388 VTE cases (1.07%) and 103 controls (0.29%) experienced bleeding, IRD: 2.19 (95% confidence interval 1.89-2.49) per 100 person-years. Following rematching at 6 months, 139 cases (0.70%) and 214 controls (1.08%) experienced bleeding, IRD: 0.70 (0.52-0.89). During initial treatment, females had a higher excess bleeding risk than males, with male IRD: 1.73 (1.34-2.12) and female IRD: 2.69 (2.23-3.15). Excess bleeding risk was highest in the oldest patient population. In extended treatment, excess bleeding was not dependent on sex-male IRD: 0.60 (0.35-0.85), female IRD: 0.81 (0.54-1.08)-and did not increase with age.</p><p><strong>Conclusion: </strong>The excess bleeding risk from anticoagulant treatment was high during initial treatment, particularly among females and the elderly, but lower and not influenced by sex or age during extended treatment.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412608","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":"Clinical, biological, and neuroimaging profiles for motoric cognitive risk syndrome in older adults: The MIND-China study.","authors":"Xiaolei Han, Qi Han, Xiaojie Wang, Rui Liu, Mingqing Zhao, Chaoqun Wang, Jiafeng Wang, Lin Song, Xiaojuan Han, Yi Dong, Giulia Grande, Miia Kivipelto, Tiia Ngandu, Yifeng Du, Yongxiang Wang, Chengxuan Qiu","doi":"10.1111/joim.20068","DOIUrl":"https://doi.org/10.1111/joim.20068","url":null,"abstract":"<p><strong>Background: </strong>Motoric cognitive risk syndrome (MCR) has been associated with dementia, functional dependence, and mortality. We sought to describe the prevalence and distribution of MCR and to explore the clinical, biological, and neuroimaging profiles for MCR in rural-dwelling Chinese older adults.</p><p><strong>Methods: </strong>This population-based study included 5021 dementia- and disability-free participants (mean age 70.3 years) in MIND-China. Of these, data were available in 1186 for blood biomarkers of Alzheimer's disease and vascular injury and in 1159 for structural brain magnetic resonance imaging biomarkers. MCR was defined as having both subjective memory complaints and gait speed ≥1 standard deviation below the age- and sex-specific means. Data were analyzed using logistic regression models and voxel-based morphometry methods.</p><p><strong>Results: </strong>The overall prevalence of MCR was 13.58%, which was higher in females than in males and increased with age. Controlling for demographic and lifestyle factors, obesity, diabetes, dyslipidemia, coronary heart disease, stroke, osteoarthritis, hip fracture, and depressive symptoms were significantly associated with an elevated likelihood of MCR (p < 0.05). MCR was significantly associated with smaller volumes of the total brain tissue, thalamus, hippocampus, cerebellum, insula, supplementary motor area, and inferior frontal gyrus, higher volumes of white matter hyperintensities, and an increased likelihood of lacunes (all p < 0.05), but not with any of the examined blood biomarkers (p > 0.05).</p><p><strong>Conclusions: </strong>MCR affects approximately one-seventh of rural-dwelling Chinese older adults. The clinical and neuroimaging profiles for MCR are characterized by cardiometabolic disorders, osteoarthritis, hip fracture, and depressive symptoms as well as global and regional brain atrophy and cerebral microvascular lesions.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389631","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":"Higher suicide risk in type 1 diabetes compared to cancer and the general population in Korea.","authors":"Seohyun Kim, So Hyun Cho, Rosa Oh, Ji Yoon Kim, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Jae Hyeon Kim, Gyuri Kim","doi":"10.1111/joim.20071","DOIUrl":"https://doi.org/10.1111/joim.20071","url":null,"abstract":"<p><strong>Background: </strong>People with diabetes have increased suicide risk. However, it is unclear whether those with type 1 diabetes (T1D) have a higher risk than those with cancer, a disease associated with significant psychological stress and suicide risk.</p><p><strong>Objectives: </strong>To evaluate suicide risk among adults with T1D compared to matched cohorts of patients with cancer and the general population.</p><p><strong>Methods: </strong>This population-based matched-cohort study examined adults aged ≥19 years (45,944 with T1D and 45,944 with cancer matched for age, sex, and index year) using data from the Korean National Health Insurance Database for January 2009-December 2015 and including 229,720 matched controls without diabetes or cancer (1:5). Composite suicide outcomes were death by suicide or hospitalization for a suicide attempt (intentional self-harm, fatal toxic substance, toxic effect of carbon monoxide, psychotropic medication, wrist laceration, fall, and asphyxia).</p><p><strong>Results: </strong>Participants had a median age of 62 years and a median follow-up duration of 10.3 years. T1D was significantly associated with an increased risk of composite suicide outcomes (adjusted hazard ratio [aHR] = 2.02; 95% confidence interval [CI] = 1.87-2.19) compared to controls. Individuals with T1D had significantly higher composite suicide outcome risk than patients with cancer (1:1) (aHR = 1.75; 95% CI = 1.55-1.97). Younger (Age < 50) and lower-income patients with T1D had a higher suicide risk than those without diabetes or cancer.</p><p><strong>Conclusion: </strong>This nationwide study demonstrated a significant association between T1D and increased suicide risk compared to the general population and patients with cancer. This underscores the importance of mental health screening and targeted interventions for this population.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389632","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":"Regarding: Obesity treatment in adolescents and adults in the era of personalized medicine.","authors":"Roberto Mazzetto, Alvise Sernicola, Mauro Alaibac","doi":"10.1111/joim.20063","DOIUrl":"https://doi.org/10.1111/joim.20063","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062636","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":"Intercontinentally validated diagnostic criteria for secondary hemophagocytic lymphohistiocytosis-So welcome!","authors":"Jan-Inge Henter","doi":"10.1111/joim.20066","DOIUrl":"https://doi.org/10.1111/joim.20066","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057463","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":"Opportunistic assessment of steatotic liver disease in lung cancer screening eligible individuals.","authors":"Jakob Weiss, Simon Bernatz, Justin Johnson, Vamsi Thiriveedhi, Raymond H Mak, Andriy Fedorov, Michael T Lu, Hugo J W L Aerts","doi":"10.1111/joim.20053","DOIUrl":"https://doi.org/10.1111/joim.20053","url":null,"abstract":"<p><strong>Background: </strong>Steatotic liver disease (SLD) is a potentially reversible condition but often goes unnoticed with the risk for end-stage liver disease.</p><p><strong>Purpose: </strong>To opportunistically estimate SLD on lung screening chest computed tomography (CT) and investigate its prognostic value in heavy smokers participating in the National Lung Screening Trial (NLST).</p><p><strong>Material and methods: </strong>We used a deep learning model to segment the liver on non-contrast-enhanced chest CT scans of 19,774 NLST participants (age 61.4 ± 5.0 years; 41.2% female) at baseline and on the 1-year follow-up scan if no cancer was detected. SLD was defined as hepatic fat fraction (HFF) ≥5% derived from Hounsfield unit measures of the segmented liver. Participants with SLD were categorized as lean (body mass index [BMI] < 25 kg/m²) and overweight (BMI ≥ 25 kg/m²). The primary outcome was all-cause mortality. Cox proportional hazard regression assessed the association between (1) SLD and mortality at baseline and (2) the association between a change in HFF and mortality within 1 year.</p><p><strong>Results: </strong>There were 5.1% (1000/19,760) all-cause deaths over a median follow-up of 6 (range, 0.8-6) years. At baseline, SLD was associated with increased mortality in lean but not in overweight/obese participants as compared to participants without SLD (hazard ratio [HR] adjusted for risk factors: 1.93 [95% confidence interval 1.52-2.45]; p = 0.001). Individuals with an increase in HFF within 1 year had a significantly worse outcome than participants with stable HFF (HR adjusted for risk factors: 1.29 [1.01-1.65]; p = 0.04).</p><p><strong>Conclusion: </strong>SLD is an independent predictor for long-term mortality in heavy smokers beyond known clinical risk factors.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044991","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":"Cardiovascular, cancer, and infection risks of Janus kinase inhibitors in rheumatoid arthritis and ulcerative colitis: A nationwide cohort study.","authors":"Yongtai Cho, Dongwon Yoon, Farzin Khosrow-Khavar, Minkyo Song, Eun Ha Kang, Ju Hwan Kim, Ju-Young Shin","doi":"10.1111/joim.20064","DOIUrl":"https://doi.org/10.1111/joim.20064","url":null,"abstract":"<p><strong>Background: </strong>Evolving evidence suggests that patients undergoing treatment with Janus kinase inhibitors (JAKi) may face an increased risk of cardiovascular events, malignancies, and serious infections.</p><p><strong>Objectives: </strong>We assessed cardiovascular, malignancy, and serious infection risks associated with JAKi use compared to tumor necrosis factor inhibitor (TNFi) use, which served as the active comparator, in patients with rheumatoid arthritis (RA) or ulcerative colitis (UC).</p><p><strong>Methods: </strong>This study emulated a target trial using South Korea's nationwide claims database (2013-2023). We constructed two separate cohorts comprising new users of JAKi or TNFi with either RA or UC and performed overlap weighting to control for confounders. Outcomes included three-point-major adverse cardiovascular events (3P-MACE) (cardiovascular death, myocardial infarction, and stroke), malignancy, and serious infection. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>The RA cohort included 14,972 patients, with 4759 initiating JAKi. The UC cohort included 2085 patients, with 347 initiating JAKi. In the overall RA cohort, the weighted HR was 0.92 (95% CI 0.59-1.42) for 3P-MACE, 1.61 (1.08-2.41) for malignancy, and 1.08 (0.94-1.23) for serious infection. In the overall UC cohort, the weighted HR was 0.98 (0.11-8.42) and 0.45 (0.26-0.78) for malignancy and serious infection, respectively. No 3P-MACE cases were observed in JAKi users.</p><p><strong>Conclusions: </strong>JAKis were associated with an elevated risk of malignancy but no significant difference in the risk of 3P-MACE and serious infection among all patients with RA. Further data are needed regarding the risk of malignancy and 3P-MACE in patients with UC.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044948","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":"Multicenter validation of secondary hemophagocytic lymphohistiocytosis diagnostic criteria.","authors":"Gunnar Lachmann, Patrick Heeren, Friederike S Schuster, Peter Nyvlt, Claudia Spies, Insa Feinkohl, Thomas Schenk, Wafa Ammouri, France Debaugnies, Lionel Galicier, Yuan Jia, Nikhil Meena, Carole Nagant, Olaf Neth, Stefan Nierkens, Juan San Martin, Hao Wei Linda Sun, Yini Wang, Zhao Wang, Jae-Ho Yoon, Frank M Brunkhorst, Paul La Rosée, Gritta Janka, Cornelia Lachmann","doi":"10.1111/joim.20065","DOIUrl":"https://doi.org/10.1111/joim.20065","url":null,"abstract":"<p><strong>Background: </strong>Five fulfilled hemophagocytic lymphohistiocytosis (HLH)-2004 criteria, and the HScore are widely used and recommended by international expert consensus to diagnose secondary HLH. Both diagnostic scores have never been validated in heterogeneous patient cohorts of secondary HLH patients. We aimed to systematically optimize and validate diagnostic criteria of secondary HLH using a multicenter approach.</p><p><strong>Methods: </strong>We developed optimized criteria in our cohort of critically ill patients as a first step. We next validated these new criteria together with the original and modified HLH-2004 criteria as well as the HScore using original data of 13 published cohorts, which were identified by a systematic literature search.</p><p><strong>Results: </strong>The best performing HLH diagnostic criteria sets over all 13 validation cohorts were the original HLH-2004 criteria with a decreased cut-off (cut-off 4, mean sensitivity 86.5%, mean specificity 86.1%), followed by the revised HLH-2004 criteria (natural killer cell activity removed; cut-off 4, mean sensitivity 83.8%, mean specificity 87.8%) and the HScore (cut-off 169, mean sensitivity 82.4%, mean specificity 87.6%). Our newly developed HLH diagnostic criteria showed inferior performance. Ferritin ≥500 µg/L had 94.0% mean sensitivity over all cohorts.</p><p><strong>Conclusions: </strong>In this first multicenter validation study, four fulfilled HLH-2004 criteria and an HScore of 169 were suitable to diagnose secondary HLH, which will lead to rapid diagnosis and improved patient outcomes. Ferritin proved as a reliable HLH screening marker. Our results should be taken into account in clinical recommendations and in designing new studies.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044987","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":"Authors reply: Obesity treatment in adolescents and adults in the era of personalized medicine.","authors":"Magnus Sundbom, Kajsa Järvholm, Lovisa Sjögren, Paulina Nowicka, Ylva Trolle Lagerros","doi":"10.1111/joim.20062","DOIUrl":"https://doi.org/10.1111/joim.20062","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035480","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":"Acknowledgement to reviewers.","authors":"","doi":"10.1111/joim.20061","DOIUrl":"https://doi.org/10.1111/joim.20061","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996952","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}