Journal of Internal Medicine最新文献

{"title":"Effects of SGLT2 inhibitors on transplant survival and key clinical outcomes in heart transplant recipients with diabetes","authors":"Fu-Shun Yen,&nbsp;Yao-Min Hung,&nbsp;Jing-Yang Huang,&nbsp;Chih-Cheng Hsu,&nbsp;Wan-Yin Cheng,&nbsp;Chii-Min Hwu,&nbsp;James Cheng-Chung Wei","doi":"10.1111/joim.20077","DOIUrl":"10.1111/joim.20077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic kidney disease and heart allograft vasculopathy are the primary causes of morbidity and mortality after cardiac transplant. This study aimed to evaluate the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on transplant survival, cardiovascular events, dialysis, and all-cause mortality in diabetes patients who have undergone heart transplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this research, we adopted data from the TriNetX collaborative network to observe outcomes in patients who underwent heart transplants between January 01, 2015 and December 31, 2022. A total of 6494 transplant recipients were identified, from which 1063 matched pairs of SGLT2i users and non-users were selected using propensity score matching. The Kaplan–Meier analysis and Cox proportional hazards models were applied to compare the risks of various outcomes between the study and control groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In propensity-matched cohorts, patients using SGLT2i exhibited a lower risk of dialysis [hazard ratio (HR) (95% confidence interval [CI]): 0.566 (0.385–0.833)], graft rejection and failure [0.873 (0.774–0.985)], hospitalizations [0.822 (0.739–0.916)], and all-cause death [0.767 (0.627–0.938)] compared to non-users. Yet, no significant differences were observed between the two groups in the risks of post-transplant infection or sepsis [0.891 (0.739–1.075)], ischemic heart disease (HR: 1.044, 95% CI: 0.939–1.161), and heart failure worsening [0.915 (0.733–1.144)].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This multicenter cohort study demonstrated that cardiac transplant recipients with diabetes who received SGLT2i had a significantly lower risk of dialysis, graft rejection, hospitalization, and all-cause mortality compared to those who did not receive SGLT2i.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"532-542"},"PeriodicalIF":9.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490311","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: the interplay of delirium and frailty in hospitalized older adults","authors":"Yanling Xu,&nbsp;Mabelline Tan Pei Min,&nbsp;Li Feng Tan","doi":"10.1111/joim.20074","DOIUrl":"10.1111/joim.20074","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"448-449"},"PeriodicalIF":9.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481963","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: The interplay of delirium and frailty in hospitalized older adults","authors":"Natalie Ling,&nbsp;Reshma Aziz Merchant,&nbsp;Zhiying Lim","doi":"10.1111/joim.20075","DOIUrl":"10.1111/joim.20075","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"450-451"},"PeriodicalIF":9.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482013","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":"The combination of statin and ezetimibe is safe, effective, and preferable","authors":"Mats Eriksson","doi":"10.1111/joim.20070","DOIUrl":"10.1111/joim.20070","url":null,"abstract":"&lt;p&gt;In this issue of the Journal of Internal Medicine, Cha et al. from the Republic of Korea reported several important findings in the article entitled “Safety and efficacy of moderate-intensity statin with ezetimibe in elderly patients with atherosclerotic cardiovascular disease” [&lt;span&gt;1&lt;/span&gt;]. The primary endpoint of the study was the incidence of statin-associated muscle symptoms (SAMSs) and the effect on low-density lipoprotein cholesterol (LDL-C) levels in elderly patients treated with high-intensity statin in monotherapy and those treated with moderate-intensity statin in combination with ezetimibe. Despite similar LDL level reductions in the two groups, a significantly lower frequency of SAMS was observed in that treated with the combination. In addition, there was a significant reduction in total cholesterol level, indicating a reduction of non-high-density lipoprotein cholesterol level (non-HDL-C), including “remnants.” Remnants have been shown to be highly atherogenic in patients with prediabetes, diabetes mellitus type 2, and kidney disease.&lt;/p&gt;&lt;p&gt;Muscular side effects of statins are seen in approximately 5% of the patients and are dose-dependent. The most severe side effect, rhabdomyolysis, is very rare (1/100,000) and has been proposed to be related to the development of auto-antibodies against HMG-CoA [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Statins have, in many studies, both in primary and secondary prevention settings, resulted in decreased morbidity and mortality in cardiovascular diseases [&lt;span&gt;3&lt;/span&gt;]. Statins are currently prescribed to more than 10% of the population in many countries.&lt;/p&gt;&lt;p&gt;Statins inhibit the endogenous synthesis of cholesterol via inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase. They are most effective in patients with a high synthesis and low cholesterol absorption [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Ezetimibe blocks the uptake of cholesterol in the small intestine. The drug was discovered without a clear understanding of the molecular target of the drug. Later, it was found that the primary target of ezetimibe is the cholesterol transporter Niemann-Pick C1-Like 1 protein, expressed by intestinal enterocytes [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;One of the first studies showing good results of combining statin with ezetimibe was the SHARP study, titled “Study of Heart and Renal Protection” [&lt;span&gt;6&lt;/span&gt;]. The study resulted in a significant 17% reduction in major atherosclerotic events in patients with kidney disease treated with simvastatin plus ezetimibe compared to simvastatin/placebo. The previous study also reported a greater decrease in total cholesterol level compared to LDL-C, indicating a reduction in remnants.&lt;/p&gt;&lt;p&gt;A second study showing the positive effects of the combination of statin and ezetimibe was the IMPROVE-IT trial titled “Improved Reduction of Outcomes: Vytorin Efficacy International trial” [&lt;span&gt;7&lt;/span&gt;]. The study included 18,144 patients with acute coronary syndromes who were randomized to treatmen","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"350-351"},"PeriodicalIF":9.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482059","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":"Wearable biosensors for monitoring and as a predictive adjunct for patients at risk for ischemic cardiac-related injury","authors":"Mayer Tenenhaus,&nbsp;Hans Oliver Rennekampff,&nbsp;George A. Vassolas","doi":"10.1111/joim.20073","DOIUrl":"10.1111/joim.20073","url":null,"abstract":"<p>Despite increased attention and preventive efforts, the prevalence of major adverse cardiovascular events continues to rise, resulting in profound concerns for both the individual and the population at large.</p><p>Rapidly evolving biotechnologies, micro-computerization, communication, and battery design have led to widespread commercial adoption, use, and dependence on smart devices, and, more recently, biosensors.</p><p>Currently worn and carried, smart devices such as mobile phones and smart watches possess impressive computational and communication capabilities, monitoring a variety of biometrics such as heart rate, blood pressure, and cardiac rhythm.</p><p>Several promising biomarkers have been identified that are expressed early in the development of cardiac injury.</p><p>Biosensors that can assay multiple variants are now described, obviating the limitations generally attributed to dependence upon a single biomarker.</p><p>Employing mathematical modeling along with intelligent learning capabilities complements and augments their potential value.</p><p>Data derived from wearable multivariate biosensors linked to already worn smart devices can communicate information to protected settings with enhanced computational capability and cogency by evaluating relayed biometrics and early expressed biomarkers as well as trending data, improving sensitivity and specificity.</p><p>Integrating intelligent learning capabilities can further power these efforts with beneficial impact on individuals and groups at risk, yielding great promise as monitoring and predictive adjuncts. Future derivations might, for those of particular concern, be linked to critical drug delivery and interventional systems.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"437-447"},"PeriodicalIF":9.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482060","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":"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}