Journal of Internal Medicine最新文献

{"title":"Angiopoietin-like protein 3 complete and partial deficiency markedly accelerates apolipoprotein B48 and B100 metabolism in triglyceride-rich lipoproteins in humans","authors":"Marcello Arca,&nbsp;Elias Björnson,&nbsp;Laura D'Erasmo,&nbsp;Alessia Di Costanzo,&nbsp;Simone Bini,&nbsp;Ilenia Minicocci,&nbsp;Daniele Tramontano,&nbsp;Stella Covino,&nbsp;Giuseppe Ciarlo,&nbsp;Manuela Lombardi,&nbsp;Sanni Söderlund,&nbsp;Niina Matikainen,&nbsp;Linda Andersson,&nbsp;Martin Adiels,&nbsp;Marja-Riitta Taskinen,&nbsp;Chris J. Packard,&nbsp;Jan Borén","doi":"10.1111/joim.70124","DOIUrl":"10.1111/joim.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Angiopoietin-like protein 3 (ANGPTL3) is a key circulating regulator of triglyceride metabolism and a promising pharmacological target. The physiological consequences of profound ANGPTL3 deficiency can be explored in individuals with inherited loss-of-function (LOF) variants, who show reduced lifetime risk of atherosclerotic cardiovascular disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ApoB48, apoB100 and TG metabolism were investigated in chylomicrons, VLDL1, VLDL2, IDL and LDL in 3 <i>ANGPTL3</i> LOF homozygotes (undetectable plasma ANGPTL3), 4 LOF heterozygotes (ANGPTL3 45.0 ± 7.4 ng/mL) and 10 matched controls (ANGPTL3 110.5 ± 27.6 ng/mL). Studies were performed under post-prandial conditions to comprehensively characterize TG transport and apoB-containing lipoprotein kinetics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Chylomicron and very-low-density lipoproteins (VLDL) production rates were similar in ANGPTL3-deficient subjects and controls. The defining abnormality in LOF homozygotes was the extremely rapid lipolysis of chylomicrons and VLDL, with circulating residence times of minutes rather than hours and accelerated conversion of VLDL to IDL and LDL. LDL particles in LOF homozygotes were TG-enriched, cholesterol-depleted, metabolically heterogeneous and cleared more rapidly than in controls or LOF heterozygotes. LOF heterozygotes showed a less pronounced increase in chylomicron and VLDL lipolysis, with normal IDL and LDL kinetics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Complete loss of ANGPTL3 results in a rapid acceleration of the triglyceride-rich lipoprotein lipolysis pathway and promotes the formation of metabolically and compositionally abnormal LDL with accelerated clearance. These findings provide mechanistic insight into ANGPTL3 deficiency and are directly relevant for the development and safety assessment of ANGPTL3-targeted therapies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 3","pages":"312-328"},"PeriodicalIF":7.6,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter validation of a severity index model for predicting postoperative acute kidney injury","authors":"Ji-Hoon Sim,&nbsp;Ah Ran Oh,&nbsp;Jaeyeon Chung,&nbsp;Jae-Woo Ju,&nbsp;Karam Nam,&nbsp;Seonok Kim,&nbsp;Bumwoo Park,&nbsp;Joung Uk Kim","doi":"10.1111/joim.70130","DOIUrl":"10.1111/joim.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Existing models for predicting postoperative acute kidney injury (AKI) after non-cardiac surgery are often complex and insufficiently validated for broad clinical use. We developed and externally validated a simple yet accurate model for predicting both overall and critical AKI that can be readily applied in routine practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The severity index model for AKI (SIM–AKI) was developed using data from 191,938 patients undergoing non-cardiac surgery at a tertiary hospital and externally validated using three independent datasets from other tertiary hospitals (<i>n </i>= 118,047; 86,092; 3727). Variables were selected using least absolute shrinkage and selection operator regression with 10-fold cross-validation, and predictor stability was assessed using backward elimination across 100 bootstrap resamples before multinomial logistic regression modeling. Model performance was evaluated using the C-statistic for discrimination, calibration plots, Brier scores, and decision curve analysis (DCA) for clinical utility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The SIM–AKI model incorporated age, sex, diabetes mellitus, American Society of Anesthesiologists classification, cancer surgery, emergency status, major abdominal surgery, anemia, hypoalbuminemia, estimated glomerular filtration rate, intraoperative transfusion, and operation time. For overall AKI, C-statistics were 0.801 (95% CI 0.796–0.806) in development and 0.754, 0.742, and 0.759 in validation cohorts. For critical AKI, C-statistics were 0.838 (95% CI 0.826–0.850) in development and 0.796, 0.805, and 0.767 in validation cohorts, demonstrating good calibration and clinical benefit in DCA. The SIM–AKI compared favorably with existing AKI prediction models in discrimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SIM–AKI may serve as a reliable perioperative tool for predicting the risk of both overall and critical postoperative AKI in patients undergoing non-cardiac surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 3","pages":"329-344"},"PeriodicalIF":7.6,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337053","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":"Placental malperfusion and angiogenesis-related proteins are associated with small-for-gestational-age in systemic lupus erythematosus.","authors":"Marit Stockfelt, Henri Puttonen, Ing-Marie Fyhr, Agnes Torell, Kerstin Andersson, Iva Gunnarsson, Elisabet Svenungsson, Agneta Zickert, Maria Majczuk Sennström, Estelle Trysberg, Anders A Bengtsson, Andreas Jönsen, Helena Strevens, Christopher Sjöwall, Muna Saleh, Sofia Pihl, Dag Leonard, Lars Rönnblom, Tansim Akhter, Bo Jacobsson, Anna-Carin Lundell, Anna Rudin","doi":"10.1111/joim.70140","DOIUrl":"10.1111/joim.70140","url":null,"abstract":"<p><strong>Background: </strong>Although systemic lupus erythematosus (SLE) pregnancy frequently results in small for gestational age (SGA) infants, the understanding of underlying mechanisms is limited. We aimed to identify specific histological patterns of placental injury in SGA in SLE and to explore whether an altered balance of angiogenesis-related proteins precedes this outcome.</p><p><strong>Methods: </strong>We prospectively followed 83 SLE and 67 control pregnancies. Placental histological patterns were determined according to the Amsterdam consensus in 63 women with SLE (76%), of whom 10 developed SGA. Soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) in plasma were quantified using LEGENDplex in the first, second and third trimesters.</p><p><strong>Results: </strong>SLE patients remain at risk of having an SGA infant, and their placentas and infants had lower weight compared to controls. In placentas from women with SLE and SGA, maternal vascular malperfusion lesions were common (80% vs. 30% in controls; p = 0.010), but inflammatory lesions were not observed. Women with maternal vascular malperfusion gave birth to infants with lower birth weight compared to women without these lesions. The ratio of sFlt-1:PlGF in the third trimester was elevated in women with SLE with an SGA infant.</p><p><strong>Conclusion: </strong>In a prospective cohort of well-controlled SLE patients with low disease activity delivering mostly at term, SGA and small placentas remain common. The increased prevalence of placental malperfusion lesions together with an altered balance of pro- and anti-angiogenic proteins suggests that the role of vascular and angiogenesis-related factors should be further explored in relation to SGA in SLE pregnancy.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560290","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: \"Global kidney health: Are we failing the silent pandemic?\"","authors":"Tae Won Yi,&nbsp;Daniel V. O'Hara,&nbsp;Adeera Levin","doi":"10.1111/joim.70114","DOIUrl":"10.1111/joim.70114","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;Thank you for the opportunity to respond to the Letter to the Editor by Drs Vidal and Trevisanuto [&lt;span&gt;1&lt;/span&gt;] regarding our article published in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; entitled “Global kidney health: Are we failing the silent pandemic?” [&lt;span&gt;2&lt;/span&gt;]. We appreciate their thoughtful emphasis on the distinct challenges associated with screening for chronic kidney disease (CKD) in the pediatric population. While our article advocates for recognizing CKD as a major global public health priority and highlights the potential value of low-cost, accessible tools such as urine dipstick screening, we agree that the implementation of these strategies requires a context-specific and nuanced approach in the pediatric population.&lt;/p&gt;&lt;p&gt;We agree that an approach targeted toward children at higher risk, including those born preterm or with low birth weight, is of highest yield. We share the concern about false positive results causing healthcare costs and child and caregiver anxiety.&lt;/p&gt;&lt;p&gt;On the other hand, we are concerned about the asymptomatic individuals likely to be missed by a targeted approach. In the example we cited of a school urinary screening program in Iran, for example, there was demonstrated success in detecting kidney disease among otherwise asymptomatic children [&lt;span&gt;3&lt;/span&gt;]. Successful programs have also been implemented in other regions [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The cost-effectiveness of large-scale screening certainly requires more investigation. In one of the studies cited in Drs Vidal and Trevisanuto's letter, for example, the incremental cost-effectiveness ratio of childhood proteinuria screening was reported as USD $2779.50 per CKD case diagnosed, but this does not consider potential lifetime benefits of early diagnosis [&lt;span&gt;5&lt;/span&gt;]. As clinicians, we expect that early detection and management of kidney disease would confer lifetime health benefits and the potential to reduce future care costs, but the magnitude of these benefits in the pediatric population remains uncertain. Although their effectiveness and safety in the pediatric population remain to be established, newer emerging therapies for CKD management may substantially influence the evolving value of screening programs [&lt;span&gt;5, 6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;While we believe that opportunistic testing at key timepoints or healthcare touchpoints, such as school entry, may remain a valuable strategy for increasing public awareness and facilitating the early identification of asymptomatic kidney disease in selected populations, we agree that a cautious approach is warranted, including further investigation of cost-effectiveness. In the interim, better implementing screening programs among those with established risk factors should be a priority.&lt;/p&gt;&lt;p&gt;The authors declare no conflicts of interest.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Tae Won Yi&lt;/b&gt;: writing - original draft, writing - review and editing. Daniel V. O'Hara: writing - original draft, writing - review and e","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 2","pages":"215-216"},"PeriodicalIF":7.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147985387","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":"Aspirin or non-steroidal anti-inflammatory drug initiation and subsequent bladder cancer evaluation","authors":"Malene Söth Hansen,&nbsp;Lars Dyrskjøt,&nbsp;Uffe Heide-Jørgensen,&nbsp;Jørgen Bjerggaard Jensen,&nbsp;Mette Nørgaard","doi":"10.1111/joim.70115","DOIUrl":"10.1111/joim.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Whether aspirin or non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) initiation may unmask unknown bladder cancers (BCs) by hematuria remains controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate unmasking, we compared cystoscopy rates, BC prevalence at cystoscopy, and invasive stage prevalence at diagnosis in aspirin or NSAID initiators with never-users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Danish population-based registries, we identified all new aspirin or NSAID users in 2005–2023 and a matched never-using comparison cohort. Second, we identified all first-time cystoscopy recipients in 2005–2022 with aspirin or NSAID initiation within 1 year prior or never-use in 10 years preceding cystoscopy. Comparing these groups, we computed hazard ratios of cystoscopy during 1-year follow-up, prevalence ratios of BC at cystoscopy, and invasive stage disease at diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 50,771 aspirin initiators (median age: 67 years, 51% men) and 156,191 NSAID initiators (age: 45 years, 50% men) adjusted hazard ratios of cystoscopy were 1.54 (95% confidence interval [CI]: 1.38–1.72) and 1.56 (95% CI: 1.43–1.70) compared with never-users. Cystoscopy recipients included 683 aspirin (age: 70 years, 69% men) and 1414 NSAID initiators (age: 60 years, 63% men); standardized morbidity ratio weighted (SMRW) prevalence ratios were 0.97 (95% CI, 0.76–1.22) and 0.65 (95% CI, 0.51–0.82) compared with never-users. The SMRW invasive stage prevalence ratios were 0.81 (95% CI, 0.63–1.03) and 1.07 (95% CI, 0.85–1.34) in the aspirin and NSAID comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combination of more cystoscopies and a lower prevalence of invasive stage at BC diagnosis may suggest the unmasking of asymptomatic BC in aspirin initiators. We did not find indications of unmasking with NSAID initiation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 2","pages":"193-203"},"PeriodicalIF":7.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136082","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: Global kidney health: Are we failing the silent pandemic?","authors":"Enrico Vidal,&nbsp;Daniele Trevisanuto","doi":"10.1111/joim.70113","DOIUrl":"10.1111/joim.70113","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;We read with great interest the recent perspective by Yi et al. on chronic kidney disease (CKD) as a “silent pandemic”, and we fully agree on the urgent need to improve early detection strategies at the global level [&lt;span&gt;1&lt;/span&gt;]. The authors appropriately emphasize that CKD is often asymptomatic in its early stages and that simple, low-cost tools such as urine dipstick testing may facilitate earlier diagnosis.&lt;/p&gt;&lt;p&gt;However, we believe that the implications of this approach in pediatric populations warrant a more cautious and nuanced interpretation. In children, the role of routine screening urinalysis has long been debated. Although inexpensive and easy to perform, dipstick screening has limited diagnostic yield in asymptomatic individuals; may generate false-positive results; and can lead to unnecessary investigations, increased healthcare costs, and potential parental anxiety. Reflecting these concerns, the American Academy of Pediatrics removed routine screening urinalysis from its health supervision guidelines in 2007 [&lt;span&gt;2&lt;/span&gt;]. Importantly, subsequent real-world data suggest that this recommendation had only a modest impact on clinical practice, with screening still performed in a substantial proportion of pediatric visits [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In addition, cost-effectiveness analyses have questioned the value of universal urine screening in children, particularly in low-risk populations [&lt;span&gt;4&lt;/span&gt;]. These considerations highlight the risk of overdiagnosis and unnecessary medicalization when screening strategies are applied indiscriminately.&lt;/p&gt;&lt;p&gt;From a pediatric nephrology perspective, a more rational approach may be to prioritize risk-based and context-specific screening strategies. Increasing evidence supports the identification of well-defined high-risk groups—such as children born preterm or with low birth weight—who may benefit from structured longitudinal kidney surveillance [&lt;span&gt;5&lt;/span&gt;]. In these populations, targeted monitoring—including assessment of proteinuria and kidney function—is biologically plausible and clinically justified, given their reduced nephron endowment and increased lifetime risk of CKD.&lt;/p&gt;&lt;p&gt;Beyond risk stratification, opportunistic screening embedded within existing healthcare pathways may represent a pragmatic alternative to population-wide programs. For example, mandatory pre-participation evaluations for sports activities—implemented in several countries—already include urine testing in some settings, although evidence suggests a low diagnostic yield and a high rate of transient or false-positive findings [&lt;span&gt;6&lt;/span&gt;]. This highlights both the limitation of indiscriminate screening and the potential of these structured encounters as platforms for more selective, risk-based testing.&lt;/p&gt;&lt;p&gt;In conclusion, while we strongly support the call to recognize CKD as a global public health priority, screening strategies in children should be carefully tailored. A shift ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 2","pages":"213-214"},"PeriodicalIF":7.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925144","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":"Amiodarone-related thyroid dysfunction and associated outcomes in patients with heart failure—A nationwide cohort study","authors":"Søren Lund Kristensen,&nbsp;Sam Aiyad Ali,&nbsp;Mads Ersbøll,&nbsp;Jawad Haider Butt,&nbsp;Rasmus Rørth,&nbsp;Lucas Malta Westergaard,&nbsp;Lauge Østergaard,&nbsp;Finn Gustafsson,&nbsp;Oren Caspi,&nbsp;Emil Fosbøl,&nbsp;Lars Køber,&nbsp;Christian Selmer","doi":"10.1111/joim.70116","DOIUrl":"10.1111/joim.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Amiodarone increases the risk of thyroid dysfunction, but the prognostic significance of this complication in patients with heart failure (HF) is uncertain. This study investigates the association between amiodarone-related thyroid dysfunction and risk of HF hospitalization or death in a nationwide cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cases and controls were identified from a source population of all HF patients who initiated treatment with amiodarone from 1996 to 2021. Patients diagnosed with and/or treated for thyroid dysfunction within 3 years of starting amiodarone were classified as cases and comprised the study population together with controls matched 1:2 based on age, sex, calendar year, and HF duration. The primary outcome was a composite of HF hospitalization and death within 1 year from onset of thyroid dysfunction, analyzed using Kaplan–Meier curves and Cox regression models adjusted for comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 21,947 HF patients who initiated amiodarone, 2972 (14%) developed thyroid dysfunction. After matching, the study population consisted of 2953 cases and 5857 controls, mean age 70 years, and 65% men. At 1-year follow-up the primary outcome occurred in 1154 (39%) cases and 1826 (31%) matched controls, yielding an adjusted hazard ratio (HR) of 1.30 (95% CI 1.21–1.40). This increased risk was observed for both HF hospitalization (30% vs. 23%, HR 1.35 [1.24–1.47]) and all-cause death (19% vs. 15%, HR 1.21 [1.08–1.34]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this nested case–control study derived from a nationwide cohort of amiodarone-treated HF patients, new-onset thyroid dysfunction was associated with a 30% higher risk of a composite of HF hospitalization and death within 1 year.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 2","pages":"204-212"},"PeriodicalIF":7.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148012748","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":"An update on drug-induced liver injury—What's new?","authors":"Einar S. Björnsson,&nbsp;Raul J. Andrade","doi":"10.1111/joim.70111","DOIUrl":"10.1111/joim.70111","url":null,"abstract":"<p>Drug-induced liver injury (DILI) is an important medical condition. Recently, development of novel causality assessment tools has improved the diagnostic accuracy of <i>idiosyncratic</i> DILI, particularly RECAM (Revised Electronic Version of Roussel Uclaf Causality Assessment [RUCAM]). RECAM was found to be better than RUCAM in difficult cases and increased the precision of the DILI diagnosis but needs further refinement. In recent years, there has been an increased incidence of DILI with drugs, such as oncological drugs and herbal and dietary supplements (HDSs). DILI is commonly associated with checkpoint-induced liver injury. Treatment with corticosteroids has been the standard of care in this type of liver injury, but its use is controversial and potentially harmful. With the help of liver biopsy, 60% of subjects can avoid corticosteroids. In recent years, a number of dietary supplements have been found to lead to DILI, such as turmeric, <i>Garcinia cambogia</i>, kratom and ashwagandha. HLA-B*35:01 has been identified as a risk factor for green tea extract-induced liver injury. International collaborative efforts have tried to find candidate biomarkers, but no biomarker has yet demonstrated superior performance to standard liver tests. FDA has recently approved the use of serum glutamate dehydrogenase (GLDH) as a biomarker to distinguish liver injury from muscle injury. Serum GLDH should be used alongside standard liver injury monitoring in patients without pre-existing liver disease. In the current review, recent findings in DILI are presented on diagnostic strategies, new agents such as checkpoint inhibitors and HDSs leading to DILI, biomarkers and new therapies.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 2","pages":"114-130"},"PeriodicalIF":7.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147831581","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":"Cancer knows no borders—Our registries do","authors":"Nikhita Santebennur,&nbsp;Jorge Gutierrez,&nbsp;Abhinav Talwar,&nbsp;David J. Fei-Zhang","doi":"10.1111/joim.70117","DOIUrl":"10.1111/joim.70117","url":null,"abstract":"&lt;p&gt;A cancer registry is a photograph: precise at the moment of capture but quickly outdated once the population beneath it begins to move. With over 120 million people forcibly displaced and 280 million international migrants reshaping host-country demographics each year [&lt;span&gt;1&lt;/span&gt;], migration is a driver of cancer burden that health systems are increasingly asked to manage. Population-based cancer registries (PBCRs) are the backbone of that burden's measurement, underpinning cancer-control programming by driving incidence estimates and informing risk stratification. Yet their utility is constrained to their fundamental architecture, designed for static populations but deployed in a world that is perpetually in motion. This mismatch between fixed design and dynamic reality is not a technical one. It is conceptual, and its consequences are clinical.&lt;/p&gt;&lt;p&gt;Hong et al.’s nationwide matched cohort of 25,798 North Korean defectors and 1,276,601 South Korean residents isolates cancer risk determinants with exceptional precision by leveraging a genetically homogenous population separated by geopolitical circumstance rather than ancestry [&lt;span&gt;2&lt;/span&gt;]. The findings reveal a dual burden. Defectors carried markedly elevated hazard ratios for liver, uterine-cervical, and lung cancer, reflecting infection-driven legacies of pre-migration exposures. They also demonstrated rising trajectories for lifestyle-related cancers such as breast and colorectal cancer as residency duration lengthened and host-country behavioral norms took hold. As a result, the study's time-varying hazard ratios convert static comparisons into risk trajectories [&lt;span&gt;2&lt;/span&gt;], highlighting not just &lt;i&gt;where&lt;/i&gt; the risk is, but &lt;i&gt;where it is going&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;This cancer risk convergence is not a Korean-specific phenomenon. Across Nordic countries, non-Western immigrant women demonstrated lower baseline risks for breast, colorectal, and lung cancers that eroded progressively with duration of residence [&lt;span&gt;3&lt;/span&gt;]. In Italy, immigrant women presented with invasive cervical cancer at more than three times the rate of Italian-born women, diagnosed nearly a decade younger, with high-risk human papillomavirus subtypes reflecting origin-country exposure [&lt;span&gt;4&lt;/span&gt;]. First-generation immigrants from Turkey, Bosnia-Herzegovina, and China also displayed elevated gastric cancer risks in the Netherlands independent of socioeconomic status [&lt;span&gt;5&lt;/span&gt;], Additionally, Vietnamese-born migrants carried liver cancer rates over five-fold higher than native Australians, with rates declining but never normalizing across decades [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The biological substrate of these legacy risks extends further. Two Epstein-Barr virus (EBV) &lt;i&gt;BALF2&lt;/i&gt; variants, nearly exclusive to Asian-origin populations, carry odds ratios of 8.69 and 6.14 for nasopharyngeal carcinomas. Together, these account for 83% of nasopharyngeal cancer risk in endemic southern China, with migrants notab","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 2","pages":"110-113"},"PeriodicalIF":7.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148025372","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":"Potassium binders and continuation of renin–angiotensin system inhibitors/mineralocorticoid receptor antagonist in chronic kidney disease and heart failure (the DEMONSTRATE database)","authors":"Hans Furuland,&nbsp;Anders Olof Larsson,&nbsp;Milica Uhde,&nbsp;Kristel Parv,&nbsp;Matilda Almstedt,&nbsp;Thomas Cars,&nbsp;Maria K. Svensson","doi":"10.1111/joim.70087","DOIUrl":"10.1111/joim.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hyperkalaemia is a serious complication in patients with chronic kidney disease (CKD) and heart failure (HF), often leading to the discontinuation of renin–angiotensin–aldosterone system inhibitors (RAASi; renin-angiotensin system inhibitors [RASi] and mineralocorticoid receptor antagonists [MRAs]) despite their cardiorenal benefits. Although potassium binders, especially second-generation potassium binders, reduce the risk of hyperkalaemia in clinical trials, real-world evidence on whether they enable RAASi continuation and influence clinical outcomes remains scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational, population-based cohort study used Swedish healthcare data from the DEMONSTRATE database to identify adults with non-dialysis (ND) CKD and/or HF who initiated potassium binders (2018–2022). Patients were stratified by potassium binder generation. RASi and MRA treatment changes were assessed at 6 months, and clinical outcomes (all-cause mortality, hospitalization and three-point major adverse cardiovascular events [3P-MACE]) were evaluated over a 3-year follow-up using propensity-score-weighted Kaplan–Meier analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 7913 potassium binder episodes (6232 patients), 7.1% used second-generation binders. These episodes were associated with increased RAASi persistence at 6 months: 76.9% and 57.5% of second-generation users maintained RASi and MRA therapy, respectively, compared with 66.4% and 47.8% in the first-generation group. Patients who maintained RASi had lower observed all-cause mortality and hospitalization rates, but no difference in incidence of 3P-MACE was found.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Second-generation potassium binders were associated with higher RAASi persistence than first-generation binders. RASi persistence was associated with lower observed rates of all-cause mortality and hospitalization, with no clear differences in 3P-MACE. These findings suggest that potassium binders may enable sustained RAASi use in patients with ND-CKD and/or HF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"300 2","pages":"179-192"},"PeriodicalIF":7.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508193","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}