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,&nbsp;Annika Rosengren,&nbsp;Sam Schulman,&nbsp;Maria Roupe,&nbsp;Tatiana Zverkova Sandström,&nbsp;Jacob Philipson,&nbsp;Kristina Svennerholm,&nbsp;Mazdak Tavoly","doi":"10.1111/joim.20067","DOIUrl":"10.1111/joim.20067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"382-399"},"PeriodicalIF":9.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20067","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":"OA","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,&nbsp;Qi Han,&nbsp;Xiaojie Wang,&nbsp;Rui Liu,&nbsp;Mingqing Zhao,&nbsp;Chaoqun Wang,&nbsp;Jiafeng Wang,&nbsp;Lin Song,&nbsp;Xiaojuan Han,&nbsp;Yi Dong,&nbsp;Giulia Grande,&nbsp;Miia Kivipelto,&nbsp;Tiia Ngandu,&nbsp;Yifeng Du,&nbsp;Yongxiang Wang,&nbsp;Chengxuan Qiu","doi":"10.1111/joim.20068","DOIUrl":"10.1111/joim.20068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p </i>&lt; 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 <i>p </i>&lt; 0.05), but not with any of the examined blood biomarkers (<i>p </i>&gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"409-422"},"PeriodicalIF":9.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20068","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":"OA","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,&nbsp;So Hyun Cho,&nbsp;Rosa Oh,&nbsp;Ji Yoon Kim,&nbsp;You-Bin Lee,&nbsp;Sang-Man Jin,&nbsp;Kyu Yeon Hur,&nbsp;Jae Hyeon Kim,&nbsp;Gyuri Kim","doi":"10.1111/joim.20071","DOIUrl":"10.1111/joim.20071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate suicide risk among adults with T1D compared to matched cohorts of patients with cancer and the general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 &lt; 50) and lower-income patients with T1D had a higher suicide risk than those without diabetes or cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"423-436"},"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,&nbsp;Alvise Sernicola,&nbsp;Mauro Alaibac","doi":"10.1111/joim.20063","DOIUrl":"10.1111/joim.20063","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We were interested to read the review by Sundbom et al. presenting a practical method to the personalized treatment of obesity [&lt;span&gt;1&lt;/span&gt;]. To support the concept of multidisciplinary therapeutic decisions, the authors consider exemplary cases when obesity is associated with neuropsychiatric disorders, stress, high alcohol intake, sleep disorders, and economic difficulties.&lt;/p&gt;&lt;p&gt;Considering the varied possibilities in the current therapeutic armamentarium for obesity, the presence of comorbidities is considered a selective clinical criterion. Therefore, we wondered whether chronic cutaneous conditions may also have a potential role in the selection of treatments for patients living with obesity and how cutaneous disorders may influence medication response and tolerability.&lt;/p&gt;&lt;p&gt;A twofold relationship between obesity and chronic inflammatory skin disorders exists: one may contribute to the development of the other, and conversely weight loss can improve skin conditions [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this context, the cutaneous effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are emerging, highlighting their potential in obesity-associated skin conditions. Recent studies have shown that GLP-1 RAs can significantly improve psoriasis severity independently of weight loss or glycemic control, potentially due to their immunomodulatory effects. GLP-1 RAs, such as liraglutide, have direct anti-inflammatory properties that reduce cytokine expression induced by TNF and IL-17 and inhibit NF-κB [&lt;span&gt;3, 4&lt;/span&gt;]. Sun et al. compared the effects of different hypoglycemic drugs on psoriasis treatment, specifically GLP-1 RAs, dipeptidyl peptidase-4 (DPP-4) inhibitors, and thiazolidinediones (TZDs): All three classes reduced the psoriasis area and severity index (PASI) scores by a mean of −9.75, −3.14, and −13.02, respectively [&lt;span&gt;5&lt;/span&gt;]. The study also found that combining hypoglycemic medications with systemic treatment for psoriasis led to a significantly better outcome, with a nearly fourfold increase in the PASI75 ratio compared to using a single medication.&lt;/p&gt;&lt;p&gt;Hidradenitis suppurativa (HS) is primarily linked to obesity and smoking. Jennings et al. presented a case of HS showing a positive response to liraglutide as well as to subsequent weight loss [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Moreover, these drugs could be valuable treatment options in diabetic patients with wound injuries not only for their hypoglycemic effect but also for their role in facilitating wound healing due to their vascular protective effect. Diabetes disrupts inflammatory responses and impairs vascular function in wounds; the activation of GLP-1R reduces inflammation and promotes angiogenesis during the early proliferation phase of wound healing in diabetic individuals [&lt;span&gt;7&lt;/span&gt;]. Additionally, GLP-1R activation supports tissue regeneration through transforming growth factor-β and matrix metalloproteinase pathways during the maturation pha","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"339-340"},"PeriodicalIF":9.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20063","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":"OA","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":"10.1111/joim.20066","url":null,"abstract":"&lt;p&gt;In this issue of the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt;, Lachmann et al. report on a multicontinental effort to validate diagnostic criteria for secondary hemophagocytic lymphohistiocytosis (sHLH) [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The report, the first multicenter diagnostic validation study for sHLH, is important for critically ill inflamed patients and their physicians because rapidly making the diagnosis of sHLH can markedly reduce its mortality and morbidity. The diagnostic criteria that performed best were the original HLH-2004 criteria (using the cutoff 4 of 8 criteria) and the recently revised HLH-2004 criteria, also termed the HLH-2024 criteria, in which NK-cell activity is removed (cutoff 4 of 7 criteria), followed by the HScore (cutoff 169 points) [&lt;span&gt;2-4&lt;/span&gt;]. Moreover, ferritin is confirmed as a reliable biomarker to screen for sHLH; ferritin ≥ 500 µg/L had a mean sensitivity of 94.0% overall in 13 validation cohorts.&lt;/p&gt;&lt;p&gt;HLH is a severe inflammatory syndrome that comes in a primary (Mendelian-inherited) form (pHLH) and a secondary (non-Mendelian) form (sHLH). sHLH is one of the most critical clinical disorders in adults; the overall mortality rate has been reported as 41% in 1109 adults [&lt;span&gt;5&lt;/span&gt;]. It is most often triggered by infections, malignancies, and autoimmune diseases. Other triggering factors include transplantation and novel drugs, such as chimeric antigen receptor (CAR) T-cells, bispecific T-cell engagers, and checkpoint inhibitors [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Prompt and accurate diagnosis of HLH is important in order to initiate adequate therapy early and thereby decrease mortality and morbidity (such as inflammatory-induced brain damage). Diagnostic criteria for pHLH in children have been available ever since 1991 [&lt;span&gt;6&lt;/span&gt;] and were revised in 2004 (“the original HLH-2004 criteria”) [&lt;span&gt;2&lt;/span&gt;] and then further revised through data-driven case–control analysis of international pediatric trial databases in 2024 (in this commentary referred to as “the HLH-2024 criteria”) [&lt;span&gt;3&lt;/span&gt;]. Notably, although the original HLH-2004 criteria and the HLH-2024 criteria were developed for children with Mendelian-inherited HLH, they have also been commonly used for adults with non-Mendelian HLH, that is, sHLH. An obvious question has therefore been: How accurate are these diagnostic criteria, and other diagnostic criteria, in sHLH?&lt;/p&gt;&lt;p&gt;In the present article, Lachmann et al. set out to answer this question and, more specifically, aimed to systematically optimize and validate diagnostic criteria of sHLH using an ambitious multicenter approach. First, they used a dataset of their own containing 2623 critically ill adult patients, of whom 40 were diagnosed with sHLH [&lt;span&gt;7, 8&lt;/span&gt;], trained a model on this dataset to systematically optimize diagnostic criteria (termed “their optimized criteria” in this commentary). Second, they conducted a systematic literature search of PubMed according to a well-defined strateg","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"240-243"},"PeriodicalIF":9.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20066","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":"OA","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,&nbsp;Simon Bernatz,&nbsp;Justin Johnson,&nbsp;Vamsi Thiriveedhi,&nbsp;Raymond H. Mak,&nbsp;Andriy Fedorov,&nbsp;Michael T. Lu,&nbsp;Hugo J. W. L. Aerts","doi":"10.1111/joim.20053","DOIUrl":"10.1111/joim.20053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Steatotic liver disease (SLD) is a potentially reversible condition but often goes unnoticed with the risk for end-stage liver disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>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] &lt; 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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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]; <i>p</i> = 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]; <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SLD is an independent predictor for long-term mortality in heavy smokers beyond known clinical risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"276-288"},"PeriodicalIF":9.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20053","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter validation of secondary hemophagocytic lymphohistiocytosis diagnostic criteria","authors":"Gunnar Lachmann,&nbsp;Patrick Heeren,&nbsp;Friederike S. Schuster,&nbsp;Peter Nyvlt,&nbsp;Claudia Spies,&nbsp;Insa Feinkohl,&nbsp;Thomas Schenk,&nbsp;Wafa Ammouri,&nbsp;France Debaugnies,&nbsp;Lionel Galicier,&nbsp;Yuan Jia,&nbsp;Nikhil Meena,&nbsp;Carole Nagant,&nbsp;Olaf Neth,&nbsp;Stefan Nierkens,&nbsp;Juan San Martin,&nbsp;Hao Wei (Linda) Sun,&nbsp;Yini Wang,&nbsp;Zhao Wang,&nbsp;Jae-Ho Yoon,&nbsp;Frank M. Brunkhorst,&nbsp;Paul La Rosée,&nbsp;Gritta Janka,&nbsp;Cornelia Lachmann","doi":"10.1111/joim.20065","DOIUrl":"10.1111/joim.20065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods:</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions:</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"312-327"},"PeriodicalIF":9.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20065","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":"OA","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,&nbsp;Dongwon Yoon,&nbsp;Farzin Khosrow-Khavar,&nbsp;Minkyo Song,&nbsp;Eun Ha Kang,&nbsp;Ju Hwan Kim,&nbsp;Ju-Young Shin","doi":"10.1111/joim.20064","DOIUrl":"10.1111/joim.20064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"366-381"},"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":"Authors reply: Obesity treatment in adolescents and adults in the era of personalized medicine","authors":"Magnus Sundbom,&nbsp;Kajsa Järvholm,&nbsp;Lovisa Sjögren,&nbsp;Paulina Nowicka,&nbsp;Ylva Trolle Lagerros","doi":"10.1111/joim.20062","DOIUrl":"10.1111/joim.20062","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;Our thanks go to Mazzetto et al. [&lt;span&gt;1&lt;/span&gt;] for their interest in our paper on personalized obesity treatment, recently published in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We welcome their comments on the interesting connection between obesity treatment and chronic cutaneous conditions, especially because these aspects are not commonly noted in clinical practice. At present, treatment with the new glucagon-like peptide-1 (GLP-1) receptor agonists is demonstrated to have beneficial effects on various conditions besides obesity and diabetes type 2, such as reducing the risk of worsened cardiovascular outcomes [&lt;span&gt;3&lt;/span&gt;] and delaying the progression of diabetes-related nephropathy [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Obesity is characterized by a state of chronic inflammation. Thus, weight loss as such could be hypothesized to lead to inflammation improvement. Nonetheless, consistent evidence from both preclinical studies and clinical trials suggests that GLP-1 receptor agonists exhibit anti-inflammatory effects influencing the immune system, irrespective of glycemic state and even before significant weight loss occurs. These potential immunomodulatory effects of GLP-1 and its agonists introduce new possibilities for treating inflammatory diseases.&lt;/p&gt;&lt;p&gt;GLP-1 receptor agonists have been shown to be associated with a decrease of inflamed airways causing asthma attacks [&lt;span&gt;5&lt;/span&gt;], to improve the inflammation in metabolic dysfunction-associated steatotic liver disease [&lt;span&gt;6&lt;/span&gt;], and as Mazzetto et al. point out [&lt;span&gt;1&lt;/span&gt;], a number of studies have also shown improvements in psoriasis, another inflammatory condition. This anti-inflammatory effect on chronic cutaneous conditions, such as psoriasis, has also been found after metabolic and bariatric surgery. GLP-1 levels substantially increase postoperatively, suggesting that the response is GLP-1 mediated.&lt;/p&gt;&lt;p&gt;In the Swedish Obese Subjects study comparing persons who had metabolic and bariatric surgery to controls with obesity, none had psoriasis at baseline. However, during 25 years of follow-up, metabolic and bariatric surgery were associated with a lower incidence of psoriasis, HR: 0.65 [0.47–0.89] [&lt;span&gt;7&lt;/span&gt;]. Interestingly, a longer duration of obesity was independently associated with a higher risk for psoriasis, thus supporting that chronic inflammation is a risk factor. However, the degree of weight loss seems important, as gastric bypass surgery reduced both the risk of new-onset psoriasis (adjusted HR 0.52 [0.33–0.81]) and progression to severe psoriasis (adjusted HR 0.44 [0.23–0.86]) in a population-based Danish study, whereas gastric banding—resulting in lower weight loss—demonstrated a slightly increased risk for both conditions with time [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this context, we would also like to remind all readers of the frequent need for excess skin removal after successful obesity treatment with significant weight","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"341-342"},"PeriodicalIF":9.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20062","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledgement to reviewers","authors":"","doi":"10.1111/joim.20061","DOIUrl":"10.1111/joim.20061","url":null,"abstract":"&lt;p&gt;The &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; acknowledges the valuable contribution of the close to 450 reviewers who have helped in the scientific evaluation of manuscripts submitted to the journal in 2024. In addition to our authors and editorial board, these individuals from all over the world have helped the journal in its goal of becoming a high-ranking international publication.&lt;/p&gt;&lt;p&gt;Abolhassani, Hassan, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Abrahamsen, Bo, &lt;i&gt;Denmark&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Alicic, Radica, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Alina, Allen, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Ambrosio, Giuseppe, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Andersson, Daniel, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Argiles, Angel, &lt;i&gt;France&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Arias, Elizabeth, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Arkema, Elizabeth, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Askling, Johan, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Asola, Markku, &lt;i&gt;Finland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Aubin, Henri-Jean, &lt;i&gt;France&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Aveyard, Paul, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Babio, Nancy, &lt;i&gt;Spain&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Baden, Megu, &lt;i&gt;Japan&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Banach, Maciej, &lt;i&gt;Poland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bellasi, Antonio, &lt;i&gt;Switzerland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bellelli, Giuseppe, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Ben-Zvi, Ilan, &lt;i&gt;Israel&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Berg Wulff, Anders, &lt;i&gt;Denmark&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bergen, Sarah&lt;i&gt;, Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Berlin, Ivan, &lt;i&gt;Switzerland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Berti, Alvise, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bertsias, George, &lt;i&gt;Greece&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Besson, Caroline, &lt;i&gt;France&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bilson, Josh, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björk, Jonas, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björkelund, Cecilia, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björkström, Karl, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björnsson, Einar, &lt;i&gt;Iceland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björnstedt, Mikael, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Blaha, Michael, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bonora, Enzo, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Boriani, Giuseppe, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Boris, Jeffrey, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bottai, Matteo, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Braunschweig, Frieder, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brennan, Paul, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brenner, Hermann, &lt;i&gt;Germany&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brismar, Torkel, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Broberg, Craig, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brown, Gregory, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brown, Jenifer Michelle, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bruchfeld, Annette, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brunström, Mattias, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bures, Jan, &lt;i&gt;Czech Republic&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Burnett, John, &lt;i&gt;Australia&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Byrne, Christopher, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Calderón-Larrañaga, Amaia, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Calvet Calvo, Xavier, &lt;i&gt;Spain&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Cameron, Natalie, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Camilleri, Michael, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Canfield, Claire Ann, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Cañas, Carlos, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Canevelli, Marco, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carballo Casla, Adrian, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carlberg, Bo, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carlsson, Axel, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carlsson, Sofia, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carsons, Steven, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Chantzichristos, Dimitrios, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Chatzidionysiou, Katerina, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Chen, Yuntao, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Cho, Young-Rak, &lt;i&gt;Korea&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Christensen, Jacob, &lt;i&gt;Norway&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Clement, ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"343-347"},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20061","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}