Journal of Internal Medicine最新文献

{"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":"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":"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":"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}

{"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":"10.1111/joim.20060","url":null,"abstract":"&lt;p&gt;For years, chronic kidney disease has been a global and growing health problem that not only significantly impairs the quality of life of patients but is also associated with high mortality and morbidity. A significant concern is the strong link between chronic kidney diseases, Type 2 diabetes mellitus, and cardiovascular disease, with cardiovascular disease being the leading cause of death among patients suffering from chronic kidney disease [&lt;span&gt;1&lt;/span&gt;]. These comorbidities exacerbate each other, significantly worsening the overall health of the patients. The high prevalence underscores the urgent need for new, integrated strategies for prevention and treatment to improve the prognosis of affected patients [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The central problem in the treatment of chronic kidney disease is that it often begins asymptomatically. The disease often goes unnoticed in its early stages, allowing valuable time to pass during which therapeutic intervention could be particularly effective. Patients are often not diagnosed until the disease is advanced, at which point therapeutic options are less effective. To close this diagnostic gap, the guidelines recommend regular monitoring of high-risk individuals, especially those with diabetes mellitus or hypertension. Two diagnostic parameters are essential in this context: the estimated glomerular filtration rate (eGFR) and the urinary albumin-to-creatinine ratio (UACR). Although eGFR tests are routinely performed, UACR tests remain underrepresented. This discrepancy leads to an underdiagnosis of chronic renal failure, as a result of which many patients are not identified and treated in time. The measurement of albuminuria is not only diagnostically relevant but also provides a basis for targeted therapeutic decisions. The increased implementation of diagnostic measures on a broader basis could help to significantly reduce the global burden of chronic renal failure and its complications in the long term.&lt;/p&gt;&lt;p&gt;In addition to the diagnostic aspects, therapeutic approaches also play a crucial role. They are essential to slow the progression of the disease and improve the quality of life of patients. However, the therapeutic focus for chronic kidney disease and Type 2 diabetes was limited to blood glucose and blood pressure control in the past, often without addressing the interconnected pathophysiological causes of cardiovascular complications. After many years of a lack of effective therapeutic options for the treatment of the early stages of chronic renal failure, there has been a remarkable development of new treatment options in recent years. These innovative approaches not only open up novel perspectives for slowing the progression of the disease but also for improving the quality of life and prognosis of affected patients.&lt;/p&gt;&lt;p&gt;First and foremost in this context are the established renin-angiotensin system inhibitors, which lower intraglomerular pressure and thus slow the progression of kidney","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 5","pages":"454-456"},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20060","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney function decline improves after lithium discontinuation","authors":"Filip Fransson,&nbsp;Ursula Werneke,&nbsp;Louise Öhlund,&nbsp;P. Andreas Jonsson,&nbsp;Michael Ott","doi":"10.1111/joim.20054","DOIUrl":"10.1111/joim.20054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Long-term lithium treatment decreases kidney function. However, it remains unclear whether stopping lithium improves kidney function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To study kidney function in patients who stopped and subsequently restarted lithium treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i> &lt; 0.0001 for difference). The improvement was 0.77 (0.35–1.20) mL/min/173 m²/year in participants with eGFR &gt;60 mL/min/1.73 m², and 3.03 (2.15–3.92) mL/min/1.73 m²/year for participants with eGFR &lt;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 (<i>p</i> &lt; 0.0001). We did not see any difference compared to the pre-mirror period (<i>p</i> = 0.51).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"289-299"},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20054","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":"OA","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,&nbsp;Caroline Hagbohm,&nbsp;Russell Ouellette,&nbsp;Tobias Granberg","doi":"10.1111/joim.20059","DOIUrl":"10.1111/joim.20059","url":null,"abstract":"<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":"297 3","pages":"244-261"},"PeriodicalIF":9.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20059","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}