Journal of Internal Medicine最新文献

{"title":"Adherence to guideline-recommended care of late-onset hypertension in females versus males: A population-based cohort study","authors":"Ann Bugeja,&nbsp;Celine Girard,&nbsp;Manish M Sood,&nbsp;Claire E Kendall,&nbsp;Ally Sweet,&nbsp;Ria Singla,&nbsp;Pouya Motazedian,&nbsp;Amanda J Vinson,&nbsp;Marcel Ruzicka,&nbsp;Gregory L. Hundemer,&nbsp;Greg Knoll,&nbsp;Daniel I McIsaac","doi":"10.1111/joim.13821","DOIUrl":"10.1111/joim.13821","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sex-based disparities in cardiovascular outcomes may be improved with appropriate hypertension management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the evidence-based evaluation and management of females with late-onset hypertension compared to males in the contemporary era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p><i>Design</i>: Retrospective population-based cohort study.</p>\u0000 \u0000 <p><i>Setting</i>: Ontario, Canada.</p>\u0000 \u0000 <p><i>Participants</i>: Residents aged ≥66 years with newly diagnosed hypertension between January 1, 2010, and December 31, 2017.</p>\u0000 \u0000 <p><i>Exposure</i>: Sex (female vs. male).</p>\u0000 \u0000 <p><i>Outcomes and Measures</i>: We used Poisson and logistic regression to estimate adjusted sex-attributable differences in the performance of guideline-recommended lab investigations. We estimated adjusted differences in time to the prescription of, and type of, first antihypertensive medication prescribed between females and males, using Cox regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 111,410 adults (mean age 73 years, 53% female, median follow-up 6.8 years), females underwent a similar number of guideline-recommended investigations (adjusted incidence rate ratio, 0.997 [95% confidence interval [CI] 0.99–1.002]) compared to males. Females were also as likely to complete all investigations (0.70% females, 0.77% males; adjusted odds ratio, 0.96 [95% CI 0.83–1.11]). Females were slightly less likely to be prescribed medication (adjusted hazard ratio [aHR] 0.98 [95% CI 0.96–0.99]) or, among those prescribed, less likely to be prescribed first-line medication (aHR, 0.995 [95% CI 0.994–0.997]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared to males, females with late-onset hypertension were equally likely to complete initial investigations with comparable prescription rates. These findings suggest that there may be no clinically meaningful sex-based differences in the initial management of late-onset hypertension to explain sex-based disparities in cardiovascular outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 3","pages":"280-290"},"PeriodicalIF":9.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13821","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141553822","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: IL-1β/DNA complex elevation distinguishes autoinflammatory disorders from autoimmune and infectious diseases","authors":"Lian Wei Zhou,&nbsp;Manling Li,&nbsp;Wenbo Li","doi":"10.1111/joim.13818","DOIUrl":"10.1111/joim.13818","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 4","pages":"377-378"},"PeriodicalIF":9.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141553824","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: IL-1β/DNA complex elevation distinguishes autoinflammatory disorders from autoimmune and infectious diseases","authors":"Anastasia-Maria Natsi,&nbsp;Efstratios Gavriilidis,&nbsp;Christina Antoniadou,&nbsp;Evangelos Papadimitriou,&nbsp;Vasileios Papadopoulos,&nbsp;Victoria Tsironidou,&nbsp;Dimitris Anastasios Palamidas,&nbsp;Loukas Chatzis,&nbsp;Eleni Sertaridou,&nbsp;Dimitrios Tsilingiris,&nbsp;Dimitrios T. Boumpas,&nbsp;Athanasios G. Tzioufas,&nbsp;Charalampos Papagoras,&nbsp;Konstantinos Ritis,&nbsp;Panagiotis Skendros","doi":"10.1111/joim.13819","DOIUrl":"10.1111/joim.13819","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 4","pages":"379"},"PeriodicalIF":9.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141553823","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":"Spinocerebellar ataxia type 4 is caused by a GGC expansion in the ZFHX3 gene and is associated with prominent dysautonomia and motor neuron signs","authors":"Martin Paucar,&nbsp;Daniel Nilsson,&nbsp;Martin Engvall,&nbsp;José Laffita-Mesa,&nbsp;Cilla Söderhäll,&nbsp;Mikael Skorpil,&nbsp;Christer Halldin,&nbsp;Patrik Fazio,&nbsp;Kristina Lagerstedt-Robinson,&nbsp;Göran Solders,&nbsp;Maria Angeria,&nbsp;Andrea Varrone,&nbsp;Mårten Risling,&nbsp;Hong Jiao,&nbsp;Inger Nennesmo,&nbsp;Anna Wedell,&nbsp;Per Svenningsson","doi":"10.1111/joim.13815","DOIUrl":"10.1111/joim.13815","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Spinocerebellar ataxia 4 (SCA4), characterized in 1996, features adult-onset ataxia, polyneuropathy, and linkage to chromosome 16q22.1; its underlying mutation has remained elusive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the radiological and neuropathological abnormalities in the entire neuroaxis in SCA4 and search for its mutation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three Swedish families with undiagnosed ataxia went through clinical, neurophysiological, and neuroimaging tests, including PET studies and genetic investigations. In four cases, neuropathological assessments of the neuroaxis were performed. Genetic testing included short read whole genome sequencing, short tandem repeat analysis with ExpansionHunter de novo, and long read sequencing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Novel features for SCA4 include dysautonomia, motor neuron affection, and abnormal eye movements. We found evidence of anticipation; neuroimaging demonstrated atrophy in the cerebellum, brainstem, and spinal cord. [¹⁸F]FDG-PET demonstrated brain hypometabolism and [¹¹C]Flumazenil-PET reduced binding in several brain lobes, insula, thalamus, hypothalamus, and cerebellum. Moderate to severe loss of Purkinje cells in the cerebellum and of motor neurons in the anterior horns of the spinal cord along with pronounced degeneration of posterior tracts was also found. Intranuclear, mainly neuronal, inclusions positive for p62 and ubiquitin were sparse but widespread in the CNS. This finding prompted assessment for nucleotide expansions. A polyglycine stretch encoding GGC expansions in the last exon of the zink finger homeobox 3 gene was identified segregating with disease and not found in 1000 controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SCA4 is a neurodegenerative disease caused by a novel GGC expansion in the coding region of <i>ZFHX3</i>, and its spectrum is expanded to include dysautonomia and neuromuscular manifestations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 3","pages":"234-248"},"PeriodicalIF":9.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141553825","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":"Performance of novel collagen turnover biomarkers to detect increased liver stiffness in MASLD","authors":"Hannes Hegmar,&nbsp;Thomas Wiggers,&nbsp;Patrik Nasr,&nbsp;Johan Vessby,&nbsp;Stergios Kechagias,&nbsp;Nils Nyhlin,&nbsp;Hanns-Ulrich Marschall,&nbsp;Åsa Danielsson Borssén,&nbsp;Rickard Strandberg,&nbsp;Morten Karsdal,&nbsp;Diana Julie Leeming,&nbsp;Mattias Ekstedt,&nbsp;Hannes Hagström","doi":"10.1111/joim.13813","DOIUrl":"10.1111/joim.13813","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cleavage products from collagen formation and degradation hold potential as first-line biomarkers for the risk of advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Here, we evaluated the performance of PRO-C3, PRO-C6, C4M, PRO-C18L, and the clinical score ADAPT (<span>a</span>ge, <span>d</span>i<span>a</span>betes, <span>P</span>RO-C3, and pla<span>t</span>elet count) to detect patients with an LSM &gt;8 kPa or &gt;12 kPa in comparison to the Fibrosis-4 Index (FIB-4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Serum from patients with MASLD (<i>n</i> = 269) from six Swedish University Hospitals was analyzed using enzyme-linked immunosorbent assay-based methods. Liver stiffness measurement (LSM) by vibration-controlled transient elastography was performed. The area under the curve (AUC), calibration curves, and net benefit analysis were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>An LSM &gt;8 kPa was found in 108 (40.1%) patients. PRO-C3, PRO-C6, C4M, and PRO-C18L had AUCs ranging from 0.48 to 0.62. ADAPT had the highest AUC (0.73, 95% confidence interval [CI] = 0.67–0.79) to detect patients &gt;8 kPa, compared to FIB-4 (0.71, (95%CI = 0.64–0.77, <i>p</i> = 0.35), and had a higher net benefit compared to FIB-4 from a probability threshold of 15%. FIB-4 and ADAPT performed equally well to detect patients with an LSM &gt;12 kPa, AUC 0.76 versus 0.76, <i>p</i> = 0.93.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ADAPT seems to be marginally better than FIB-4 in identifying patients with an LSM &gt;8 kPa. However, the clinical utility of ADAPT as a first line test is uncertain, especially in low-risk populations. The overall performance of FIB-4 was similar to that of ADAPT in detecting patients with an LSM of &gt;12 kPa. Altogether, the results suggest that ADAPT might be useful to detect earlier stages of fibrosis in MASLD, but that FIB-4 remains a first-line test for advanced fibrosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 2","pages":"177-186"},"PeriodicalIF":9.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496519","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":"Revealing the distinct clinical patterns and relapse risk factors in seronegative IgG4-RD patients: A retrospective cohort study over a decade","authors":"Yu Peng,&nbsp;Mu Wang,&nbsp;Ruijie Sun,&nbsp;Yuxue Nie,&nbsp;Nianyi Zhang,&nbsp;Xin He,&nbsp;Boyuan Sun,&nbsp;Linyi Peng,&nbsp;Yunyun Fei,&nbsp;Jiaxin Zhou,&nbsp;Mengtao Li,&nbsp;Wen Zhang","doi":"10.1111/joim.13814","DOIUrl":"10.1111/joim.13814","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Our study aimed to investigate the distinct clinical patterns of seronegative IgG4-related disease (IgG4-RD) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively enrolled 698 treatment-naïve IgG4-RD patients in this study. Patients were divided into four different subgroups according to their baseline serum IgG4 levels. The distinct clinical patterns of seronegative IgG4-RD patients were revealed through the comparison of baseline clinical data and disease prognosis among the different subgroups. COX regression analyses were used to investigate the risk factors for disease relapse and to construct the nomogram model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seronegative IgG4-RD patients account for a minority of IgG4-RD patients (49/698, 7.02%). The proportions of seronegative IgG-RD patients in our study and several Asian cohorts were significantly lower than those of the European and American cohorts. Seronegative IgG4-RD patients got lower serum IgG levels (<i>p </i>&lt; 0.0001), lower eosinophil count (<i>p</i> &lt; 0.0001), lower serum IgE levels (<i>p </i>&lt; 0.0001)), lower IgG4-RD responder index (RI) scores (<i>p</i> &lt; 0.0001), and fewer affected organ numbers (<i>p </i>&lt; 0.0001) compared with other subgroups, whereas they were more likely to manifest fibrotic type with some special organ involvement. Younger age at onset, GCs monotherapy, elevated C-reactive protein level, and elevated erythrocyte sedimentation rate level are the risk factors for the disease relapse of seronegative IgG4-RD patients. An effective nomogram model predicting disease relapse of seronegative IgG4-RD patients was constructed. Seronegative IgG4-RD patients with scores &gt;84.65 at baseline were susceptible to suffering from disease relapse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Distinct clinical features and multiple risk factors for disease relapse of seronegative IgG4-RD patients have been revealed in this study. A nomogram model was constructed to effectively predict disease relapse during the follow-up period.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 2","pages":"200-212"},"PeriodicalIF":9.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454117","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":"Making the best use of quantitative fecal immunochemical test results in colorectal cancer screening","authors":"Hermann Brenner,&nbsp;Michael Hoffmeister","doi":"10.1111/joim.13812","DOIUrl":"10.1111/joim.13812","url":null,"abstract":"&lt;p&gt;Fecal immunochemical tests (FITs) have become the most widely used tests for colorectal cancer (CRC) screening [&lt;span&gt;1&lt;/span&gt;]. They detect the vast majority of CRCs and some proportion of advanced precancerous neoplasms [&lt;span&gt;2&lt;/span&gt;], and modeling studies suggest that annual or biennial FIT-based screening programs have the potential to substantially lower the burden of CRC incidence and mortality [&lt;span&gt;3&lt;/span&gt;]. Yet, uncertainty prevails with respect to the optimal use of FITs regarding a number of key parameters of screening programs, such as the starting age of screening, screening intervals, and positivity thresholds of FITs. In this issue, Westerberg et al. reported most valuable results from the baseline exam of the large Swedish SCREESCO screening trial that may inform the design and planning of screening programs [&lt;span&gt;4&lt;/span&gt;]. In particular, the study allows thorough evaluation of the tradeoffs between increasing the positive predictive value (PPV) and the decreasing numbers needed to undergo colonoscopy (“numbers needed to scope”, NNS) on one hand, and decreasing sensitivity on the other hand, when increasing the FIT positivity threshold from 10 μg hemoglobin (Hb)/g feces to higher levels. These data may be most valuable for multiple purposes, including the provision of key background information for more comprehensive modeling of the effectiveness and cost-effectiveness of various screening strategies.&lt;/p&gt;&lt;p&gt;However, in the interpretation of the results, a number of additional factors require careful consideration. In the SCREESCO trial, two FITs per screening round were applied, and the overall test result was rated as positive if one of the two FITs showed an Hb concentration &gt;10 μg/g feces in the baseline scenario, or &gt;20, 40, 60, 80, 120, or 160 μg/g in the alternative scenarios. By contrast, in most screening programs, just one FIT is employed per screening round. Defining the result as positive if one of two tests is positive increases the sensitivity and decreases the specificity compared to the application of a single test. This implies that comparable positivity rates and sensitivity would be expected at somewhat lower cutoffs in one-sample rather than two-sample testing, which should be kept in mind in interpreting the presented data. It remains an open question whether two-sample testing is worth the extra effort and cost. Possibly, (almost) equivalent results as those reported by Westerberg et al. could be obtained with one-sample testing by lowering the FIT cutoff [&lt;span&gt;5&lt;/span&gt;]. Further analyses of the dataset by Westerberg et al. may offer unique opportunities to answer this question.&lt;/p&gt;&lt;p&gt;Another important aspect to keep in mind is that all the results reported by Westerberg et al. refer to a first-round FIT screening. With annual or biennial FIT-based screening, as recommended and practiced in many countries, the prevalences of advanced neoplasms will decrease at subsequent screening rounds. Altho","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 2","pages":"118-120"},"PeriodicalIF":9.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13812","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417043","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":"Colonoscopy findings after increasing two-stool faecal immunochemical test (FIT) cut-off: Cross-sectional analysis of the SCREESCO randomized trial","authors":"Marcus Westerberg,&nbsp;Julia Eriksson,&nbsp;Chris Metcalfe,&nbsp;Christian Löwbeer,&nbsp;Anders Ekbom,&nbsp;Robert Steele,&nbsp;Lars Holmberg,&nbsp;Anna Forsberg","doi":"10.1111/joim.13810","DOIUrl":"10.1111/joim.13810","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We determined the impact of an increased two-stool faecal immunochemical test (FIT) cut-off on colonoscopy positivity and relative sensitivity and specificity in the randomized controlled screening trial screening of Swedish colons conducted in Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a cross-sectional analysis of participants in the FIT arm that performed FIT between March 2014 and 2020 within the study registered with ClinicalTrials.gov, NCT02078804, who had a faecal haemoglobin concentration of at least 10 µg/g in at least one of two stool samples and who underwent a colonoscopy (<i>n</i> = 3841). For each increase in cut-off, we computed the positive predictive value (PPV), numbers needed to scope (NNS), sensitivity and specificity for finding colorectal cancer (CRC) and advanced neoplasia (AN; advanced adenoma or CRC) relative to cut-off 10 µg/g.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PPV for AN increased from 23.0% (95% confidence intervals [CI]: 22.3%–23.6%) at cut-off 10 µg/g to 28.8% (95% CI: 27.8%–29.7%) and 33.1% (95% CI: 31.9%–34.4%) at cut-offs 20 and 40 µg/g, respectively, whereas the NNS to find a CRC correspondingly decreased from 41 to 27 and 19. The PPV for AN was higher in men than women at each cut-off, for example 31.5% (95% CI: 30.1%–32.8%) in men and 25.6% (95% CI: 24.3%–27.0%) in women at 20 µg/g. The relative sensitivity and relative specificity were similar in men and women at each cut-off.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A low cut-off of around 20–40 µg/g allows detection and removal of many AN compared to 10 µg/g while reducing the number of colonoscopies in both men and women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 2","pages":"187-199"},"PeriodicalIF":9.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13810","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141282500","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":"Has mortality in the United States returned to pre-pandemic levels? An analysis of provisional 2023 data","authors":"Abdul Mannan Khan Minhas,&nbsp;Marat Fudim,&nbsp;Erin D. Michos,&nbsp;Dmitry Abramov","doi":"10.1111/joim.13811","DOIUrl":"10.1111/joim.13811","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The COVID-19 pandemic, which started in 2020, resulted in greater all-cause mortality in 2020 and in subsequent years. Whether all-cause mortality remains elevated in 2023 compared to pre-pandemic numbers is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>The United States (US) Center for Disease Control Wide-Ranging, Online Data for Epidemiologic Research database was used to compare mortality rates between 2019 and provisional data for 2022 and 2023. Age-adjusted mortality rates (AAMRs) for all-cause as well as top causes of mortality were collected. Mortality based on subgroups by sex, age, and ethnicity was also collected. All-cause AAMRs between 2018 and 2023 per 100,000 individuals were 723.6, 715.2, 835.4, 879.7, (provisionally) 798.8, and (provisionally) 738.3, respectively, with AAMRs in 2023 remaining above 2019 pre-pandemic levels. Similar trends were noted in subgroups based on sex, ethnicity, and most age groups. Mortality attributed directly to COVID-19 peaked in 2021 as the 3rd leading cause of death and dropped to the 10th leading cause in 2023. Provisional mortality rate trends for 2023 suggest that rates for diseases of the heart increased during the pandemic but appear to have returned to or dipped below pre-pandemic levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Provisional 2023 all-cause mortality rates in the US have decreased from the 2021 peak associated with the COVID-19 pandemic but remain above the pre-pandemic baseline. Mortality from some conditions, including diseases of the heart, appears to have recovered from the impact of the COVID-19 pandemic.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 2","pages":"168-176"},"PeriodicalIF":9.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141198838","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":"Circadian and ultradian rhythms: Clinical implications","authors":"Stafford L. Lightman,&nbsp;Becky L. Conway-Campbell","doi":"10.1111/joim.13795","DOIUrl":"10.1111/joim.13795","url":null,"abstract":"<p>The hypothalamic–pituitary–adrenal axis is an extremely dynamic system with a combination of both circadian and ultradian oscillations. This state of ‘continuous dynamic equilibration’ provides a platform that is able to anticipate events, is sensitive in its response to stressors, remains robust during perturbations of both the internal and external environments and shows plasticity to adapt to a changed environment. In this review, we describe these oscillations of glucocorticoid (GC) hormones and why they are so important for GC-dependent gene activation in the brain and liver, and their consequent effects on the regulation of synaptic and memory function as well as appetite control and metabolic regulation. Abnormalities of mood, appetite and metabolic regulation are well-known consequences of GC therapy, and we suggest that the pattern of GC treatment and hormone replacement should be a much higher priority for endocrinologists and the pharmaceutical industry. One of the major impediments to our research on the importance of these cortisol rhythms in our patients has been our inability to measure repeated levels of hormones across the day in patients in their home or work surroundings. We describe how new wearable methodologies now allow the measurement of 24-h cortisol profiles – including during sleep – and will enable us to define physiological normality and allow us both to develop better diagnostic tests and inform, at an individual patient level, how to improve replacement therapy.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 2","pages":"121-138"},"PeriodicalIF":9.0,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13795","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141198837","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}