Journal of Internal Medicine最新文献

{"title":"Diagnosis and treatment of chronic kidney diseases and Type 2 diabetes mellitus: a paradigm shift for enhancing cardiovascular prognosis.","authors":"Joachim Jankowski","doi":"10.1111/joim.20060","DOIUrl":"https://doi.org/10.1111/joim.20060","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":"142996956","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":"Kidney function decline improves after lithium discontinuation.","authors":"Filip Fransson, Ursula Werneke, Louise Öhlund, P Andreas Jonsson, Michael Ott","doi":"10.1111/joim.20054","DOIUrl":"https://doi.org/10.1111/joim.20054","url":null,"abstract":"<p><strong>Background: </strong>Long-term lithium treatment decreases kidney function. However, it remains unclear whether stopping lithium improves kidney function.</p><p><strong>Objectives: </strong>To study kidney function in patients who stopped and subsequently restarted lithium treatment.</p><p><strong>Methods: </strong>Mirror-image design using data from the LiSIE retrospective cohort study. The mirror was set to when lithium was stopped with a 5-year pre- and post-mirror period. Adult patients with bipolar, schizoaffective disorder or unipolar depression, who had lithium ≥4.5 years in the pre-mirror period, were included. Creatinine measurements were available from 1997 to 2017. The main outcome was the difference in mean annual change of the estimated glomerular filtration rate (eGFR) adjusted for sex, hypertension and diabetes mellitus.</p><p><strong>Results: </strong>A total of 168 participants (94 women, 74 men) were included. Mean annual eGFR change was -1.58 (-1.87 to -1.28) mL/min/1.73 m²/year before and -0.023 (-0.49 to +0.44) mL/min/1.73 m²/year after lithium discontinuation (p < 0.0001 for difference). The improvement was 0.77 (0.35-1.20) mL/min/173 m²/year in participants with eGFR >60 mL/min/1.73 m², and 3.03 (2.15-3.92) mL/min/1.73 m²/year for participants with eGFR <30 mL/min/1.73 m². The effect was persistent over the 5-year post-mirror study period. For participants restarting lithium, the mean annual eGFR change was -1.71 (-2.26 to -1.16) mL/min/1.73 m²/year, a setback compared to their lithium-free post-mirror period (p < 0.0001). We did not see any difference compared to the pre-mirror period (p = 0.51).</p><p><strong>Conclusions: </strong>Stopping lithium slowed down mean eGFR decline. This effect was more pronounced in participants with lower eGFR at the time of lithium discontinuation. In participants who restarted lithium, the annual decline of eGFR reverted to pre-lithium discontinuation levels.</p>","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":"142997079","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":"Challenges and opportunities in organ donation after circulatory death","authors":"Mathias Vidgren,&nbsp;Capucine Delorme,&nbsp;Gabriel C. Oniscu","doi":"10.1111/joim.20051","DOIUrl":"10.1111/joim.20051","url":null,"abstract":"<p>In recent years, there has been resurgence in donation after circulatory death (DCD). Despite that, the number of organs transplanted from these donors remains low due to concerns about their function and a lack of an objective assessment at the time of donation. This overview examines the current DCD practices and the classification modifications to accommodate regional perspectives. Several risk factors underscore the reluctance to accept DCD organs, and we discuss the modern strategies to mitigate them. The advent of machine perfusion technology has revolutionized the field of DCD transplantation, leading to improved outcomes and better organ usage. With many strategies at our disposal, there is an urgent need for comparative trials to determine the optimal use of perfusion technologies for each donated organ type. Additional progress in defining therapeutic strategies to repair the damage sustained during the dying process should further improve DCD organ utilization and outcomes. However, there remains wide variability in access to DCD donation and transplantation, and organizational efforts should be doubled up with consensus on key ethical issues that still surround DCD donation in the era of machine perfusion.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"124-140"},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996953","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":"Regarding: Delirium and frailty in older adults: Clinical overlap and biological underpinnings","authors":"José Lucas Sena da Silva,&nbsp;Juliana Caldas","doi":"10.1111/joim.20048","DOIUrl":"10.1111/joim.20048","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;The review by Bellelli et al. recently published in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; examines the relationship between frailty and delirium—two geriatric syndromes that significantly impact morbidity, mortality, functionality, cognition, quality of life, healthcare costs, and caregiver burden [&lt;span&gt;1&lt;/span&gt;]. The authors assess the current evidence regarding how these conditions share risk factors, prevalence, consequences, and pathophysiology and whether they potentially constitute a syndrome in their own right. Although their findings are of significant importance and raise other compelling discussions, we would like to offer some additional comments for consideration.&lt;/p&gt;&lt;p&gt;First, their findings highlight our limitations in understanding the pathophysiology of these conditions. It is noteworthy that various medications targeting different mechanisms thought to be involved in the occurrence of delirium are being investigated for prevention and treatment. However, the results remain inconsistent and do not significantly influence severity, duration, or recurrence [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;It is also pertinent to question how frequently we underdiagnose cognitive decline upon hospital admission. We know that this decline often goes unnoticed by family members and caregivers, making it less likely to be spontaneously reported in clinical settings. Such an assessment is crucial for investigating a possible connection between frailty and delirium, given that cognitive decline is a common risk factor for both conditions, though it may be less evident for the untrained eye in the earlier stages.&lt;/p&gt;&lt;p&gt;Moreover, we face a clinical reality—previously highlighted by large studies—regarding the inconsistency of clinical practices in delirium prevention. We must ask whether—were these protocols to be effectively implemented—we could prevent delirium even in frail patients. This would contribute to either reinforcing or undermining the hypothesis of a singular syndrome. Nevertheless, we still lack high-quality clinical evidence regarding the best strategies for preventing delirium, let alone their consistent implementation in clinical practice [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;It seems imperative to engage in a multidisciplinary approach to the prevention of these conditions. While this may entail short-term increases in healthcare expenditures for ongoing education of clinical teams, hiring additional staff, and logistical reorganization, studies on delirium suggest that its prevention may result in reduced rates of hospital length of stay and readmission [&lt;span&gt;4&lt;/span&gt;]. Moreover, frail patients who develop delirium are more susceptible to a feedback loop of these conditions, which can lead to adverse clinical outcomes, including increased rates of infection, hospitalization, and intensive care unit admissions, as well as the utilization of sedatives.&lt;/p&gt;&lt;p&gt;It is important to note that although the review by Bellelli et al. contributes ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"230-231"},"PeriodicalIF":9.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982018","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":"Clinical 7 Tesla magnetic resonance imaging: Impact and patient value in neurological disorders.","authors":"Elisabeth de Vries, Caroline Hagbohm, Russell Ouellette, Tobias Granberg","doi":"10.1111/joim.20059","DOIUrl":"https://doi.org/10.1111/joim.20059","url":null,"abstract":"<p><p>Magnetic resonance imaging (MRI) is a cornerstone of non-invasive diagnostics and treatment monitoring, particularly for diseases of the central nervous system. Although 1.5- and 3 Tesla (T) field strengths remain the clinical standard, the advent of 7 T MRI represents a transformative step forward, offering superior spatial resolution, contrast, and sensitivity for visualizing neuroanatomy, metabolism, and function. Recent innovations, including parallel transmission and deep learning-based reconstruction, have resolved many prior technical challenges of 7 T MRI, enabling its routine clinical use. This review examines the diagnostic impact, patient value, and practical considerations of 7 T MRI, emphasizing its role in facilitating earlier diagnoses and improving care in conditions, such as amyotrophic lateral sclerosis (ALS), epilepsy, multiple sclerosis (MS), dementia, parkinsonism, tumors, and vascular diseases. Based on insights from over 1200 clinical scans with a second-generation 7 T system, the review highlights disease-specific biomarkers such as the motor band sign in ALS and the new diagnostic markers in MS, the central vein sign, and paramagnetic rim lesions. The unparalleled ability of 7 T MRI to study neurological diseases ex vivo at ultra-high resolution is also explored, offering new opportunities to understand pathophysiology and identify novel treatment targets. Additionally, the review provides a clinical perspective on patient handling and safety considerations, addressing challenges and practicalities associated with clinical 7 T MRI. By bridging research and clinical practice, 7 T MRI has the potential to redefine neuroimaging and advance the understanding and management of complex neurological disorders.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941921","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":"Metabolic syndrome is associated with breast cancer mortality: A systematic review and meta-analysis.","authors":"Sixten Harborg, Helene Borup Larsen, Stine Elsgaard, Signe Borgquist","doi":"10.1111/joim.20052","DOIUrl":"https://doi.org/10.1111/joim.20052","url":null,"abstract":"<p><strong>Background: </strong>This systematic review and meta-analysis assesses the association between metabolic syndrome and breast cancer (BC) outcomes in BC survivors.</p><p><strong>Methods: </strong>Systematic searches were carried out in PubMed and Embase using variations of the search terms: breast neoplasms (population), metabolic syndrome (exposure), and survival (outcome). Metabolic syndrome was characterized according to the American Heart Association, which includes the presence of three out of five abnormal findings among the risk factors: high blood pressure, high triglycerides, low high-density lipoprotein, high fasting glucose, and central obesity. Data were obtained from observational studies and randomized controlled trials that utilized survival statistics and reported survival ratios to investigate how the presence of metabolic syndrome at the time of BC diagnosis is associated with BC outcomes. Study data were independently extracted by two authors, and effect sizes were pooled using random-effects models.</p><p><strong>Results: </strong>From the 1019 studies identified in the literature search, 17 were deemed eligible. These encompassed 42,135 BC survivors. The pooled estimates revealed that BC survivors who had metabolic syndrome at the time of their BC diagnosis experienced increased risk of recurrence (HR 1.69, 95% CI: 1.39-2.06), BC mortality (HR 1.83, 95% CI: 1.35-2.49), and shorter disease-free survival (HR 1.57, 95% CI: 1.36-1.81) compared to BC survivors without metabolic syndrome.</p><p><strong>Conclusions: </strong>Among BC survivors, metabolic syndrome was associated with inferior BC outcomes. This necessitates the creation of clinical guidelines that include metabolic screening for BC survivors. Further research should identify effective interventions to reduce the prevalence of metabolic syndrome among BC survivors to improve metabolic health and BC outcomes.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941974","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":"Epidemiology and outcomes of alpha-1 antitrypsin deficiency in Sweden 2002-2020: A population-based cohort study of 2286 individuals.","authors":"Staffan Wahlin, Linnea Widman, Hannes Hagström","doi":"10.1111/joim.20058","DOIUrl":"https://doi.org/10.1111/joim.20058","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the incidence, prevalence, and outcomes of patients with diagnosed alpha-1-antitrypsin deficiency (AATD) in Sweden, 2002-2020.</p><p><strong>Study design and setting: </strong>The Swedish National Patient Registry was utilized to identify patients with a first diagnosis of AATD between 2002 and 2020. Each patient was matched with up to 10 comparators from the general population. AATD incidence and prevalence were estimated. Causes of death and rates of mortality, transplantation, lung disease, liver cirrhosis, and previous neonatal cholestasis were estimated.</p><p><strong>Results: </strong>The incidence rate of AATD was 1.83 (95% confidence interval [CI] 1.58-2.11) per 100,000 person-years and the total prevalence was 21.04 (95%CI = 20.17-21.94) per 100,000 persons at the end of 2020. Mortality was 3.55 times higher (95%CI = 3.15-3.99) for patients with AATD. Rates of liver-(hazard ratio [HR] = 22.95, 95%CI = 12.61-41.75), lung-(HR = 12.09, 95%CI = 8.87-16.47), and cardiovascular (HR = 1.90, 95%CI = 1.45-2.90) related death were higher in patients with AATD. The cumulative incidence after 10 years of follow-up was 1.69% (95%CI = 1.15-2.41) for liver transplantation and 4.14% (95%CI = 3.20-5.26) for lung transplantation. About 20% of patients were estimated to be alive without lung disease or liver cirrhosis 20 years after an AATD diagnosis. Neonatal cholestasis codes were found in 3.0% of AATD patients and 0.5% of comparators (odds ratio 6.28, 95%CI = 3.81-10.36).</p><p><strong>Conclusions: </strong>In this population-based cohort study on AATD in Sweden, an increasing incidence was observed, and significantly higher rates of death from liver, lung, and cardiovascular causes compared to the general population were found. Only a minority of diagnosed AATD patients were estimated to be free of liver cirrhosis and lung disease after 20 years.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941925","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":"Differential long-term impact of primary glomerular diseases on major outcomes: All are not equal!","authors":"Austin G Stack","doi":"10.1111/joim.20057","DOIUrl":"https://doi.org/10.1111/joim.20057","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913398","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: Alpha-1 antitrypsin deficiency associated with increased risks of skin cancer, leukemia, and hepatic cancer: A nationwide cohort study","authors":"Malin Fromme,&nbsp;Katharina Remih,&nbsp;Carolin Victoria Schneider,&nbsp;Pavel Strnad","doi":"10.1111/joim.20055","DOIUrl":"10.1111/joim.20055","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"234-235"},"PeriodicalIF":9.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908727","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: Alpha-1 antitrypsin deficiency associated with increased risks of skin cancer, leukemia, and hepatic cancer: A nationwide cohort study","authors":"Eskild M. Landt,&nbsp;Sarah C. W. Marott,&nbsp;Morten Dahl","doi":"10.1111/joim.20056","DOIUrl":"10.1111/joim.20056","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"236-237"},"PeriodicalIF":9.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908724","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}