Journal of Internal Medicine最新文献

{"title":"Upcoming therapies for steatotic liver disease: Translating breakthroughs into clinical practice","authors":"Philip N. Newsome,&nbsp;Saima Ajaz","doi":"10.1111/joim.70143","DOIUrl":"10.1111/joim.70143","url":null,"abstract":"<p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and a leading cause of cirrhosis, hepatocellular carcinoma, and cardiometabolic morbidity. Often clinically silent until advanced fibrosis develops, management has largely relied on lifestyle interventions, with limited pharmacological options and inconsistent risk stratification. Recent advances in noninvasive diagnostics and targeted therapies are beginning to transform this approach. This review examines the evolving management paradigm of MASLD and metabolic dysfunction-associated steatohepatitis (MASH), focusing on practical implementation of fibrosis-based risk stratification, structured care pathways, and newly approved or late-stage pharmacological therapies. Recent clinical trials demonstrate that therapies targeting metabolic dysfunction and hepatic fibrogenesis can improve steatohepatitis and fibrosis, particularly in patients with advanced disease. Incretin-based therapies have shown MASH resolution in approximately 40%–60% of patients, accompanied by weight loss of 10%–20%, whereas thyroid hormone receptor-β agonists have demonstrated substantial reductions in liver fat and improvements in fibrosis-related endpoints. Emerging fibroblast growth factor analogs and combination therapeutic approaches suggest additive benefit through complementary metabolic and anti-fibrotic mechanisms. Together, these advances support treatment strategies guided by fibrosis risk rather than steatosis alone. MASLD care is therefore moving from reactive disease management toward structured pathways that integrate scalable diagnostics with disease-modifying therapy, offering the potential to alter disease progression and reduce the burden of advanced liver disease.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 4","pages":"440-460"},"PeriodicalIF":7.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862944","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":"Patients with hereditary hemorrhagic telangiectasia have significantly reduced overall survival—And likely by a greater magnitude than we realize","authors":"Hanny Al-Samkari","doi":"10.1111/joim.70135","DOIUrl":"10.1111/joim.70135","url":null,"abstract":"&lt;p&gt;In this issue of &lt;i&gt;JIM&lt;/i&gt;, Ahlström Emanuelsson et al. report the estimated mortality of patients with hereditary hemorrhagic telangiectasia (HHT) compared with age- and gender-matched controls from the general population from the Swedish National Patient Register [&lt;span&gt;1&lt;/span&gt;]. They found a significant reduction in life expectancy in patients with HHT (73 years) compared with controls from the general population (81 years), with increased mortality becoming clearly apparent after age 30 and with known complications of HHT among the most common causes of death. The study employed rigorous, fit-for-purpose methodology and evaluated the entire population of a country, thereby allowing for minimization of bias from localized clusters of families or proximity to university hospitals. Notably, Sweden lacks a specialized HHT referral center; care at such centers, known as HHT Centers of Excellence, have been demonstrated to result in improved clinical outcomes in these patients. The findings of this study carry three critical lessons: (1) The morbidity of HHT is substantial, and this disease carries a major burden of unmet need; (2) there is a clear need for many more HHT Centers of Excellence throughout the world; and (3) in combination with other recent major registry and database studies in HHT [&lt;span&gt;2, 3&lt;/span&gt;], it becomes clear that the estimated elevated mortality burden of HHT in this study is likely to be an underestimate.&lt;/p&gt;&lt;p&gt;HHT, an autosomal dominant vasculopathy, is the second-most-common inherited bleeding disorder worldwide and the most morbid inherited bleeding disorder of women [&lt;span&gt;4, 5&lt;/span&gt;]. It causes moderate-to-severe mucosal bleeding manifestations—including recurrent epistaxis, chronic gastrointestinal bleeding, and/or heavy menstrual bleeding—in three-quarters of patients, along with the highest modern incidence of potentially fatal organ hemorrhage (intrapulmonary hemorrhage in 2% and intracranial hemorrhage in 3%) of any of the major inherited bleeding disorders (hemophilia, HHT, and von Willebrand disease) [&lt;span&gt;2&lt;/span&gt;]. The burden of iron deficiency anemia is profound, the highest among the inherited bleeding disorders, affecting most patients and not infrequently causing dependence on hematologic support with intravenous iron or red cell transfusions [&lt;span&gt;2, 3, 6&lt;/span&gt;]. Arteriovenous malformations (AVMs) in lung, liver, and brain additionally contribute to a high burden of thromboembolic and other non-bleeding complications, including venous or arterial thromboembolism in 1 in 6 patients; major neurologic complications in 1 in 5 patients; and major cardiopulmonary disease (heart failure or pulmonary hypertension) in 1 in 10 patients [&lt;span&gt;2&lt;/span&gt;]. With this burden of disease, the findings of the new report from Ahlström Emanuelsson et al. are not surprising. However, both their mortality and prevalence estimates are very likely to be underestimates.&lt;/p&gt;&lt;p&gt;The average delay from the mean age at init","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 4","pages":"393-396"},"PeriodicalIF":7.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148373951","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":"Expected survival is decreased in hereditary hemorrhagic telangiectasia: Results from a population-based registry study","authors":"Cecilia Ahlström Emanuelsson,&nbsp;Anders Ehnhage,&nbsp;Mats Holmström,&nbsp;Oskar Hagberg,&nbsp;Marit Westman","doi":"10.1111/joim.70134","DOIUrl":"10.1111/joim.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disorder associated with substantial morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study was to estimate mortality in a country without centralized national care for HHT patients. Moreover, we identified causes of death and estimated the prevalence of HHT in Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Swedish National Patient Register (NPR) was used to identify individuals with HHT using the International Classification of Diseases (ICD) code I78.0. Cases included all individuals with this code between January 1, 2001 and December 31, 2003 (<i>n</i> = 393). Five age- and gender-matched controls from the general population were selected by Statistics Sweden (SCB) (<i>n</i> = 1965). Cases and controls were followed for survival until 2018 using the Swedish National Cause of Death Register (DORS). To calculate prevalence, we identified all individuals with the ICD code I78.0 in the NPR over 12 years, from January 1, 2007 to December 30, 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Life expectancy for cases with HHT after age 30 was estimated at 73.0 (68.0–77.2) compared to 80.5 (79.1–82.0) years for controls. Ischemic heart diseases, diseases of arteries, arterioles, capillaries, and liver diseases were significantly more common causes of death among HHT patients. The prevalence of HHT was estimated at 9.3 per 100,000 over the 12 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HHT in Sweden is associated with markedly shorter expected survival compared to the general population, and known complications of HHT are among the most common causes of death. The estimated prevalence of HHT in Sweden was relatively low, possibly due to underdiagnosis of those with milder symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 4","pages":"480-488"},"PeriodicalIF":7.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395321","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":"An update on biofilms in acute and chronic wounds: Incidence, clinical evidence, diagnosis, prevention, and treatment","authors":"Steven L. Percival,&nbsp;Marcus J. Swann,&nbsp;Kristian Daly,&nbsp;Dieter O. Mayer,&nbsp;Prashini Moodley,&nbsp;Rui Chen","doi":"10.1111/joim.70138","DOIUrl":"10.1111/joim.70138","url":null,"abstract":"<p>Pathogenic biofilms are a critical barrier to wound healing, driving infection persistence, delayed tissue repair, and antimicrobial resistance (AMR) and tolerance. This recognition has driven a paradigm shift from a traditional planktonic model of infection to a biofilm-mediated framework, where structured microbial communities are encased within a protective extracellular polymeric substance (EPS) matrix. These communities are highly prevalent in chronic wounds, with reported detection rates of 60%–100% across diabetic foot ulcers, venous leg ulcers, and pressure injuries. The establishment of biofilms fundamentally alters host–microbe interactions, promotes antimicrobial tolerance, and triggers therapeutic failure, prolonged inflammation, and wound chronicity. Despite their clinical relevance, management strategies remain limited. Crucially, a lack of rapid point-of-care diagnostics and standardized clinical endpoints hampers timely intervention. Conventional culture based methods frequently fail to detect sessile microbial populations, necessitating advanced techniques such as next-generation sequencing or confocal microscopy, which are largely unavailable in routine practice. A detailed understanding of the molecular and cellular mechanisms underpinning biofilm persistence is essential to translate knowledge into targeted clinical interventions. Effective management requires a biofilm centric, multimodal strategy that prioritizes regular mechanical debridement to disrupt the EPS matrix, supported by proactive exudate control and appropriate topical therapies. Looking forward, advances in diagnostic technologies, artificial intelligence (AI)-assisted analysis, and matrix disrupting or permeating agents offer significant potential. Furthermore, emerging biological therapies, including bacteriophages, promise to help transform wound management, reduce the burden of AMR, and potentially improve patient outcomes globally.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 4","pages":"420-439"},"PeriodicalIF":7.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148682855","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":"Genomics comes of age: From research tool to routine care","authors":"Edwin Cuppen","doi":"10.1111/joim.70126","DOIUrl":"10.1111/joim.70126","url":null,"abstract":"&lt;p&gt;Few areas of medicine have been transformed as rapidly, and as quietly, as diagnostics. Within little more than a decade, high-throughput sequencing has moved from the research bench into routine clinical use, reshaping how we diagnose rare disease, classify and treat cancer, track pathogens, and tailor drug therapy [&lt;span&gt;1&lt;/span&gt;]. In this issue of the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt;, Edsjö et al. report that more than half a million genomic tests were performed in Swedish healthcare between 2017 and 2025 under the banner of Genomic Medicine Sweden (GMS) [&lt;span&gt;2&lt;/span&gt;]. Beyond the headline number, their account is a useful vantage point from which to consider where genomic medicine now stands, and where the technology that drives it is heading.&lt;/p&gt;&lt;p&gt;Precision medicine rests on a simple premise: that care tailored to the molecular features of an individual patient will outperform care designed for the average one. Genomics is the discipline that makes that premise operational. A single sequencing assay can establish a diagnosis in a child with an unexplained syndrome, define the mutations driving a leukemia, reveal a germline predisposition that reshapes surveillance for an entire family, identify the resistance determinants of a pathogen, or flag a pharmacogenomic variant that should change a drug dose before the first prescription is written. In each case, the same underlying data, the sequence, answers a different clinical question. That versatility is what distinguishes genomics from earlier, single-purpose laboratory tests and is why it has become the connective tissue of precision medicine rather than one tool among many.&lt;/p&gt;&lt;p&gt;The clinical case is now well established. Whole-genome and exome sequencing resolve a substantial fraction of previously undiagnosed rare disease, on the order of a third of cases in trio analyses, ending diagnostic odysseys that once spanned years and, for many families, delivering an answer in time to alter management rather than merely to explain it [&lt;span&gt;3&lt;/span&gt;]. Pan-cancer whole-genome studies have shown that complete profiling captures the full spectrum of driver alterations, including the structural and copy-number changes that targeted panels miss [&lt;span&gt;4&lt;/span&gt;]. Comprehensive and complete genome analyses in routine cancer diagnostics positively impact patient outcomes [&lt;span&gt;5&lt;/span&gt;]. Because a genome, unlike a fixed-content panel, can be reinterpreted as knowledge advances, a sequence generated today retains diagnostic value tomorrow. The patient is tested once; the genome keeps giving answers, so that a child left undiagnosed today may be solved by reanalysis tomorrow without a single further sample.&lt;/p&gt;&lt;p&gt;What makes the present moment distinctive is not that genomics works, but that the technology underpinning it is undergoing a step change. The clearest example is the displacement of older methods, classical cytogenetics, fluorescence in situ hybridization, and successive targeted assay","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 4","pages":"390-392"},"PeriodicalIF":7.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417125","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":"European Consortium for Lipodystrophies consensus definition and classification framework for monogenic lipodystrophy.","authors":"Robert K Semple, Martin Wabitsch, Baris Akinci, Saif Alyaarubi, Marjoleine F Broekema, Rebecca J Brown, Giovanni Ceccarini, Carolina Cecchetti, Solaf M Elsayed, Antía Fernández-Pombo, Alessandra Gambineri, Ingrid M Jazet, Lotte Kleinendorst, Konstanze Miehle, Elif A Oral, Flavia Prodam, Ferruccio Santini, David B Savage, Nadia Shaukat Ali, Ekaterina Sorkina, Magdalena Szopa, Marie-Christine Vantyghem, Camille Vatier, Corinne Vigouroux, Julia von Schnurbein, David Araújo-Vilar","doi":"10.1111/joim.70157","DOIUrl":"https://doi.org/10.1111/joim.70157","url":null,"abstract":"<p><p>Lipodystrophy comprises a heterogeneous group of disorders characterized by reduced adipose tissue often associated with severe metabolic complications. Lipodystrophy may be genetic, acquired, or secondary to medical therapies initiated for other conditions. Despite major advances in understanding adipose tissue biology and in human genetic technologies, diagnosis of lipodystrophy is still commonly delayed or missed. Conversely, increasing use of next-generation sequencing has led to proliferation of proposed new genetic causes of lipodystrophy with variable supporting evidence. To address these challenges, an international expert working group from the European Consortium for Lipodystrophies first developed a consensus definition of lipodystrophy as deficient development and/or inadequate maintenance of adipose tissue not attributable to nutritional deprivation or a systemic catabolic state. Anatomical adipose deficiency alone is generally insufficient for diagnosis, with evidence of adipose tissue dysfunction or pathology also usually required. Building on this definition, a framework for evaluating candidate monogenic lipodystrophy syndromes is suggested, based on the strength of human phenotypic, genetic, and biological evidence. Primacy was assigned to direct evidence from affected individuals, with genetic and biological evidence considered supportive but not determinative. This approach accommodates both the variable penetrance and expressivity characteristic of many lipodystrophy syndromes and potential discrepancies between human observations and experimental models. Although the proposed definition is applicable across all forms of lipodystrophy, the classification system described here is restricted to monogenic disorders. Together, these tools aim to improve clinical recognition, promote diagnostic consistency, and provide a robust and adaptable framework for evaluating emerging gene-disease associations in lipodystrophy.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872280","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":"Sepsis care and management: Where do we stand?","authors":"Evangelos J Giamarellos-Bourboulis","doi":"10.1111/joim.70154","DOIUrl":"https://doi.org/10.1111/joim.70154","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148786404","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":"International multidisciplinary consensus statement on sepsis code guidelines: A Delphi approach.","authors":"M Borges-Sa, A Giglio, I Martin-Loeches, J Nates, J M González Del Castillo, Y Cárdenas, P Mergulhao, F J Candel, R Zaragoza, M N Larrosa-Escartin, P Vidal-Cortés, E Maseda, R Reina, J A Paiva, J L Del Pozo, M V Villegas, M Salavert, C Soriano, J Hidalgo, I Machuca, J Gonçalves-Pereira, A Manuel-Vázquez, T Lisboa, M Pichardo-Viñas, J Barberán, G Esparza, G Castillo-Abrego, A Estella, K Ortega, A Matos, N Raimondi, R Ferrer, J R Sanchez, I Huelmo, L A Gorordo-Delsol, V Campozano, A Soriano, J Perez, A Rodriguez","doi":"10.1111/joim.70145","DOIUrl":"10.1111/joim.70145","url":null,"abstract":"<p><strong>Background: </strong>Sepsis remains a major global health challenge. International guidelines exist, but their implementation is inconsistent, and supporting evidence largely comes from high-income settings. The objective of this study was to generate international, multidisciplinary expert consensus on controversial aspects of sepsis management within the framework of sepsis code programs.</p><p><strong>Methods: </strong>A multinational modified Delphi study was conducted with 164 experts from 22 countries, 12 specialties, and 105 scientific societies. Seven domains were evaluated: early diagnosis, biomarkers, diagnostic microbiology, hemodynamic monitoring, source control, antimicrobial therapy, and hemodynamic management. Consensus was defined as ≥70% agreement across three iterative rounds using Likert scales (Rounds 1-2) and binary format (Round 3).</p><p><strong>Results: </strong>Consensus was achieved for 40 statements. Strong endorsement (82%-95%) was reached for structured hospital sepsis programs, NEWS-2 as the preferred early recognition tool, biomarker use (notably procalcitonin) to complement clinical assessment, urgent source control within 6 h independent of hemodynamic status, rapid molecular diagnostics integrated with antimicrobial stewardship, and norepinephrine as first-line vasopressor therapy. Experts also supported pharmacokinetic- and pharmacodynamic-guided antibiotic dosing, prolonged infusion of time-dependent agents, and dynamic rather than fixed fluid strategies. No consensus was reached on routine reliance on Sepsis-2, Sepsis-3, or qSOFA; high mean arterial pressure targets; or universal combination antimicrobial therapy.</p><p><strong>Conclusions: </strong>These results provide multidisciplinary guidance for sepsis management, with emphasis on rapid recognition, targeted antimicrobial therapy, timely source control, and hemodynamic management guided by patient physiology. The recommendations are applicable to high- and middle-income healthcare systems.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720966","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":"Stopping or continuing chronic antihypertensive therapy during hospitalization","authors":"Ziv Ribak,&nbsp;Jacob David Miller,&nbsp;Nitzan Burrack,&nbsp;Victor Novack,&nbsp;Ran Abuhasira","doi":"10.1111/joim.70093","DOIUrl":"10.1111/joim.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Elevated blood pressure is common among hospitalized patients, but the effects of withholding chronic antihypertensive therapy during hospitalization remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the association between continuation versus discontinuation of chronic antihypertensive medications during hospitalization and short- and long-term outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective propensity score–matched cohort study included adults (≥18 years) with chronic hypertension hospitalized in eight Clalit Health Services hospitals in Israel from January 2014 to May 2024. Eligible patients had received at least one antihypertensive medication continuously for 6 months before admission. Discontinuation was defined as omission of ≥1 chronic medication during hospitalization. Outcomes included in-hospital and 90-day acute kidney injury (AKI), myocardial injury, stroke, and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After 1:1 propensity matching, 82,230 patients were analyzed (50,070 internal medicine; 32,160 surgical). In internal medicine departments, discontinuation was associated with higher risk of in-hospital AKI (OR, 1.23; 95% CI, 1.16–1.30), 90-day AKI (OR, 1.19; 95% CI, 1.14–1.24), in-hospital mortality (OR, 2.69; 95% CI, 2.47–2.94), and 90-day mortality (OR, 1.81; 95% CI, 1.72–1.90). In surgical departments, discontinuation was linked to in-hospital myocardial injury (OR, 1.26; 95% CI, 1.10–1.44) but not AKI. Results were consistent across subgroups, including infection-related admissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Discontinuing chronic antihypertensive therapy during hospitalization was associated with increased risks of AKI and mortality. These findings suggest that withholding antihypertensive therapy is unlikely to confer benefit and may be harmful.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 3","pages":"284-298"},"PeriodicalIF":7.6,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607513","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 long and winding road of postural orthostatic tachycardia syndrome","authors":"Artur Fedorowski","doi":"10.1111/joim.70121","DOIUrl":"10.1111/joim.70121","url":null,"abstract":"&lt;p&gt;Postural orthostatic tachycardia syndrome (POTS) is widely described as a chronic disorder of cardiovascular autonomic regulation, characterized by an exaggerated increase in heart rate upon standing [&lt;span&gt;1&lt;/span&gt;]. The condition disproportionately affects women of reproductive age [&lt;span&gt;2&lt;/span&gt;]. However, the clinical manifestations of POTS extend far beyond the cardiovascular system. Patients frequently experience a broad spectrum of symptoms, including exercise intolerance, cognitive difficulties such as impaired memory and concentration, gastrointestinal disturbances, and sleep disruption—often as prominently as palpitations and orthostatic intolerance [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Despite its substantial impact on quality of life, the long-term trajectory of POTS remains uncertain: Is it a lifelong condition or one from which patients may recover spontaneously?&lt;/p&gt;&lt;p&gt;The relevance of this question has grown substantially in the wake of the COVID-19 pandemic [&lt;span&gt;4&lt;/span&gt;]. The incidence and, consequently, prevalence of POTS have increased markedly post-pandemic, with estimates suggesting up to a six-fold rise of the total POTS prevalence in population [&lt;span&gt;5&lt;/span&gt;]. Among individuals with long COVID, approximately one third meet diagnostic criteria for POTS, sharing the multi-systemic symptom burden of long COVID with circulatory dysregulation characteristic for POTS [&lt;span&gt;6&lt;/span&gt;]. Notably, the presence of POTS is associated with more severe long COVID manifestations, yet its impact on long-term prognosis remains unclear [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue, Bourne et al. present data from a very long follow-up of POTS patients [&lt;span&gt;8&lt;/span&gt;]. The authors contacted around 120 patients previously investigated and diagnosed with POTS at the Vanderbilt Autonomic Center in Nashville, USA, between 1987 and 2014. The majority responded, and more than one third completed the online survey, exploring the symptom evolution and applied measures between the onset of POTS, the diagnosis, and the time point for survey.&lt;/p&gt;&lt;p&gt;Here, a word of caution is needed: Individuals with persistent symptoms may have been more motivated to participate, whereas those with full recovery—or, conversely, those most severely affected—may have been underrepresented. Thus, it is impossible to assess in an objective way how representative this rather small patient sample is for the general population of POTS patients.&lt;/p&gt;&lt;p&gt;In the final cohort of 46 patients with POTS who completed the study, the median disease duration was 23 years, whereas the median time between diagnosis and the survey was 17 years, offering a very long follow-up time, by far exceeding the current studies on long COVID, which also include POTS patients.&lt;/p&gt;&lt;p&gt;The most striking observation was the persistence symptom over decades in nearly all participants. However, the disease trajectories differed: just over half reported a gradual improvement, whereas the rest declared worsening of symptoms","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 3","pages":"220-222"},"PeriodicalIF":7.6,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136059","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}