Journal of Internal Medicine最新文献

{"title":"Regarding: Time to initiation of extracorporeal membrane oxygenation in conventional cardiopulmonary resuscitation affects the patient survival prognosis","authors":"Xiao Liu,&nbsp;Bo Liu,&nbsp;Minli Yang,&nbsp;Liu Yang,&nbsp;Jun Wang","doi":"10.1111/joim.20022","DOIUrl":"10.1111/joim.20022","url":null,"abstract":"<p>The article by Sim et al. [<span>1</span>] in the <i>Journal of Internal Medicine</i> emphasized the critical role of timely ECMO application in optimizing outcomes for patients undergoing ECPR. While recognizing the careful work and valuable contributions of this study, there are some constructive suggestions for future advancement.</p><p>First, although the study accounted for various adjustment factors, it may have overlooked some potential influencing variables, such as patient comorbidities or changes in treatment protocols following ECMO initiation. These factors could affect the reliability and validity of the study's results [<span>2</span>].</p><p>Second, in the study, the Cox proportional hazards assumption may be violated for several reasons: time dependency: If the effect of ECMO initiation on survival varies over time, it breaches the assumption that hazard ratios remain constant throughout the study period; sample heterogeneity: Variability in patient characteristics within the sample may cause fluctuations in hazard ratios, thus violating the proportionality assumption; lack of testing: Without assessing the proportional hazards assumption using methods like Schoenfeld residuals, undetected violations could compromise the model's validity. Addressing these issues is crucial for ensuring the robustness and accuracy of the Cox regression analysis [<span>3</span>].</p><p>Third, the study primarily focuses on short-term outcomes (e.g., 30 days, 90 days, and 6 months), and there may be insufficient assessment of long-term survival and quality of life [<span>4</span>]. It is recommended that future research includes extended follow-up periods to obtain more comprehensive prognostic information.</p><p>In conclusion, the results of this study emphasize that the early initiation of ECMO during ECPR significantly improves short- and long-term overall survival outcomes. It highlights the need for prospective, multi-center research, long-term follow-up, standardized protocols, and optimization of procedures to improve clinical practices and patient survival.</p><p><b>Xiao Liu</b>: Conceptualization; methodology; writing—original draft; validation. <b>Bo Liu</b>: Writing—review and editing. <b>Minli Yang</b>: Methodology; supervision. <b>Liu Yang</b>: Methodology; writing—review and editing. <b>Jun Wang</b>: Writing—review and editing; supervision.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"535-536"},"PeriodicalIF":9.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491711","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: Time to initiation of extracorporeal membrane oxygenation in conventional cardiopulmonary resuscitation affects the patient survival prognosis","authors":"Wei-Zhen Tang,&nbsp;Zhe-Ming Kang,&nbsp;Tai-Hang Liu","doi":"10.1111/joim.20021","DOIUrl":"10.1111/joim.20021","url":null,"abstract":"&lt;p&gt;After a thorough analysis of the study by Ji-Hoon Sim et al., published in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt;, we express our appreciation for their findings that the early initiation of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR) significantly improves short- and long-term survival outcomes. The study highlights the critical role of timely ECMO application in enhancing treatment results for patients receiving extracorporeal PCR (ECPR) [&lt;span&gt;1&lt;/span&gt;]. Nevertheless, we believe there are several key issues within the study that could impact the interpretation of the results.&lt;/p&gt;&lt;p&gt;First, the exclusion criteria of the study did not specifically mention whether certain populations that could significantly affect the study conclusions were excluded. These include patients over the age of 75, those with end-stage malignancies, those requiring ongoing life support, patients with cardiac tamponade due to aortic dissection, and those with persistent intracranial hemorrhage or severe brain injury [&lt;span&gt;2&lt;/span&gt;]. For instance, elderly patients may have different physiological characteristics and disease risks, which could affect their response to treatment and recovery capabilities compared to younger patients. The overall health status and life expectancy of patients with end-stage malignancies are already severely compromised. If these patients were not properly excluded, their inclusion could lower overall survival rates, thereby affecting the assessment of ECMO efficacy. Patients who required continuous life support prior to cardiac arrest may have a poorer baseline health status, which could influence the accuracy of the study's findings regarding the relationship between the timing of ECMO initiation and survival rates.&lt;/p&gt;&lt;p&gt;Second, although the study distinguished between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest patients, it did not detail whether key pre-hospital characteristics of OHCA patients were recorded [&lt;span&gt;2&lt;/span&gt;]. Such characteristics include the time of collapse, the presence of a witness, bystander CPR, the occurrence of transient return of spontaneous circulation before hospital arrival, initial shockable rhythm, and the interval from collapse to the initiation of CPR. Pre-hospital constraints may delay the start of ECMO, thereby prolonging the duration of low blood flow in patients, affecting organ perfusion and, ultimately, prognosis [&lt;span&gt;3&lt;/span&gt;]. Moreover, the ECMO outcomes for OHCA patients may be affected by the quality of emergency medical services and pre-hospital treatment systems. The difficulty of manual CPR during ambulance transport suggests that mechanical CPR before the start of ECMO could yield different survival outcomes. The lack of these data could limit a comprehensive understanding of the pre-hospital situation and resuscitation process for OHCA patients, which is crucial for analysing the impact of the CPR-to-ECMO interval on p","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"533-534"},"PeriodicalIF":9.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors reply: Time to initiation of extracorporeal membrane oxygenation in conventional cardiopulmonary resuscitation affects the patient survival prognosis","authors":"Sang-Wook Lee,&nbsp;Ji-Hoon Sim","doi":"10.1111/joim.20023","DOIUrl":"10.1111/joim.20023","url":null,"abstract":"&lt;p&gt;We appreciate the opportunity to respond to the three Letters to the Editor [&lt;span&gt;1-3&lt;/span&gt;] commenting on our article [&lt;span&gt;4&lt;/span&gt;], published in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt;. We have carefully discussed them with the respective authors. We want to express our sincere gratitude for their interest in our work and for the valuable suggestions they have provided.&lt;/p&gt;&lt;p&gt;First, we would like to address the concern raised in all three letters regarding the absence of clear exclusion criteria for comorbidities in our study group [&lt;span&gt;4, 5&lt;/span&gt;]. We fully acknowledge and agree with the points raised by the authors of the letters. Although we share their concerns, our study was based on a retrospective data analysis. Consequently, we opted to address these effects by applying statistical corrections in a multivariate analysis rather than excluding them from our study altogether. We agree that in future prospective studies on this topic, it is indeed crucial to thoroughly consider and incorporate multiple factors that may influence patient outcomes into the exclusion criteria.&lt;/p&gt;&lt;p&gt;Second, we would like to address their comments regarding the significant prehospital characteristics of out-of-hospital cardiac arrest (OHCA) patients highlighted in the study. We concur with the authors that there are numerous factors specific to OHCA patients, as opposed to in-hospital cardiac arrest (IHCA) patients, that can influence outcomes [&lt;span&gt;6&lt;/span&gt;]. Indeed, it may be more effective to analyse OHCA patients separately from IHCA patients to reach more definitive conclusions. OHCA patients often face more challenges that can delay extracorporeal membrane oxygenation (ECMO) initiation, and in our data, these factors were associated with a poorer prognosis compared to IHCA patients. In future research, it would be advantageous to analyse OHCA patients separately from IHCA patients using a larger dataset to derive clearer insights on these issues.&lt;/p&gt;&lt;p&gt;Third, we would like to comment on the issues raised by the authors regarding the specific details of post-cardiac arrest care. We agree that various post-cardiac arrest interventions—such as blood transfusions, ventilator settings, treatment of infectious complications, and therapeutic temperature management—as well as complications occurring during ECMO, such as insertion site bleeding, limb ischemia, and intracranial hemorrhage, are critical factors that impact the prognosis of cardiac arrest patients [&lt;span&gt;7, 8&lt;/span&gt;]. Unfortunately, our study lacked sufficient data in this area to present detailed results. We recognize that detailed descriptions of these post-cardiac arrest treatments and complications may be crucial in understanding the prognosis of ECPR patients, and future studies should include these details and better assess their impact on outcomes.&lt;/p&gt;&lt;p&gt;Finally, we would like to respond to the point raised by the authors regarding the insufficient evaluation of long-term outcomes ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"537-538"},"PeriodicalIF":9.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491707","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":"Increased risk of hypereosinophilia following initiation of glucagon-like peptide 1 receptor agonist: A symmetry analysis using the Danish health registries","authors":"Martin Torp Rahbek,&nbsp;Søren Andreas Just,&nbsp;Kasper Bruun Kristensen,&nbsp;Hussam Mahmoud Sheta,&nbsp;Jesper Hallas,&nbsp;Anton Pottegård,&nbsp;Lars Christian Lund","doi":"10.1111/joim.20025","DOIUrl":"10.1111/joim.20025","url":null,"abstract":"&lt;p&gt;Glucagon-like peptide 1 receptor agonists (GLP1-RA) are increasingly used in the treatment of Type 2 diabetes and as antiobesity drugs. Cases of hypereosinophilic syndrome (HES) following initiation of GLP1-RA have been reported [&lt;span&gt;1&lt;/span&gt;]. HES is defined by eosinophil counts of 1.5 × 10&lt;sup&gt;9&lt;/sup&gt;/L or greater and related end-organ damage [&lt;span&gt;2&lt;/span&gt;]. Because these events are too rare to be detected in randomized controlled trials, we aimed to quantify the association between GLP1-RA initiation and incident hypereosinophilia (HE) using real-world data.&lt;/p&gt;&lt;p&gt;Leveraging nationwide Danish prescription [&lt;span&gt;3&lt;/span&gt;] and laboratory data [&lt;span&gt;4&lt;/span&gt;], we conducted a sequence symmetry analysis (SSA) investigating the occurrence of HE following initiation of GLP1-RA and for comparison sodium–glucose co-transporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase 4 inhibitors (DPP4i) [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The SSA compares the occurrence of HE during a symmetric time window before and after initiation of the drug of interest. If there is no association between drug initiation and HE, we would expect HE to occur equally often during both windows. However, if GLP1-RA use increases eosinophil counts, we would expect HE to occur more frequently after initiation. The sequence ratio (SR) is calculated as the number of HE events after drug initiation divided by the number of HE events before drug initiation and corresponds to the incidence rate ratio obtained in the corresponding cohort study [&lt;span&gt;6&lt;/span&gt;]. If the rate of HE is increased after initiation of GLP1-RA compared to the period before initiation, we would expect an SR above 1.&lt;/p&gt;&lt;p&gt;We identified all individuals who initiated a GLP1-RA, SGLT2i or DPP4i (Appendix) between 1 June 2015 and 31 May 2024 and obtained eosinophil counts of 1.5 × 10&lt;sup&gt;9&lt;/sup&gt;/L or greater within the last 180 days before the drug initiation, or within the first 180 days after. Observed SRs were adjusted for temporal trends in HE [&lt;span&gt;5&lt;/span&gt;]. In subgroup analyses, we evaluated semaglutide and other GLP1-RAs separately, as well as Ozempic and Wegovy. For sensitivity analyses, we calculated SRs for observation windows of 90 and 365 days and with mild (≥0.5–1.5 × 10&lt;sup&gt;9&lt;/sup&gt;/L) and massive eosinophilia (≥5 × 10&lt;sup&gt;9&lt;/sup&gt;/L) as outcomes. Finally, we used a thrombocyte count below 50 × 10&lt;sup&gt;9&lt;/sup&gt;/L as a negative control outcome.&lt;/p&gt;&lt;p&gt;The study was approved by the institutional data protection board at the University of Southern Denmark and the Danish Health Data Authority (Project number FSEID-00006047). Ethical approval is not needed in Denmark for studies based purely on registry data.&lt;/p&gt;&lt;p&gt;We identified 213,521 individuals who initiated a GLP1-RA among whom 245 had HE within 1 year of drug initiation. The median age was 54 years (interquartile range [IQR] 42–63), 49% were female and median year of initiation of GLP1-RA was 2022 (IQR 2021–2023&lt;i&gt;)&lt;/i&gt;. Of these, 193 individuals had HE afte","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"527-530"},"PeriodicalIF":9.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491708","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: Time to initiation of extracorporeal membrane oxygenation in conventional cardiopulmonary resuscitation affects the patient survival prognosis","authors":"Zegang Ruan,&nbsp;Yuhao Gan,&nbsp;Chenyang Xu","doi":"10.1111/joim.20020","DOIUrl":"10.1111/joim.20020","url":null,"abstract":"<p>Dear Editor,</p><p>We read with great interest the article by Sim et al. [<span>1</span>] published in the <i>Journal of Internal Medicine</i>. The authors conducted a retrospective study involving 198 patients to examine the impact of extracorporeal membrane oxygenation (ECMO) initiation timing during routine cardiopulmonary resuscitation (CPR) on patient survival prognosis. The study's findings underscore the crucial role of ECMO in routine CPR, particularly highlighting that an early initiation of ECMO significantly enhances patient survival outcomes. We commend the authors for optimizing the timing of ECMO initiation in clinical practice. However, several aspects warrant further discussion.</p><p>First, the article selectively analysed patients who received ECMO but did not provide detailed information regarding the exclusion and selection criteria. For instance, there is no clear explanation of how patients with severe comorbidities or a higher risk of death were managed. This omission could result in a non-representative sample, potentially affecting the generalizability of the study's conclusions.</p><p>Second, the article inadequately addresses the neurological prognosis of the patients, as it fails to include data on their long-term neurological outcomes post-discharge (after 3 or 6 months). Given that neurological recovery following cardiac arrest may take an extended period [<span>2</span>], this limitation hinders a comprehensive understanding of the patient's long-term prognosis.</p><p>Third, although the article focuses on the timing of ECMO initiation, it does not analyse other concurrent treatments (e.g., high-quality CPR, medications, and temperature management) compared to ECMO. This omission prevents a clear delineation of ECMO's unique contribution relative to other interventions throughout the treatment process [<span>3</span>].</p><p>In conclusion, we appreciate the authors for highlighting the significance of timely ECMO initiation during CPR to improve patient survival. This work will raise healthcare professionals’ awareness of the critical importance of early ECMO initiation and contribute to the rapid advancement of this field.</p><p><b>Zegang Ruan</b>: Methodology; writing—original draft; investigation. <b>Yuhao Gan</b>: Methodology; writing—original draft; investigation. <b>Chenyang Xu</b>: Writing—review and editing; supervision.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"531-532"},"PeriodicalIF":9.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491709","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":"Neck triangle nerve enlargement in hereditary transthyretin amyloidosis correlates with changes in the autonomic, cardiac, and gastrointestinal systems","authors":"Hsueh-Wen Hsueh,&nbsp;Chi-Chao Chao,&nbsp;Yen-Hung Lin,&nbsp;Ping-Huei Tseng,&nbsp;Mao-Yuan Su,&nbsp;Sung-Tsang Hsieh","doi":"10.1111/joim.20019","DOIUrl":"10.1111/joim.20019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hereditary transthyretin amyloidosis (ATTRv) is a hereditary disease that affects multiple bodily systems. Although sonography generally reveals enlargement of nerves in the limbs, the brachial plexus, and vagus nerve, the clinical significance of these findings remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed sonographic measurements of the median nerve, cervical spinal nerves at the C5–C7 level, and the vagus nerve in patients with ATTRv and healthy controls. Clinical profiles and cardiac and gastrointestinal examination results were also collected for linear regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 47 patients with ATTRv (males/females: 34/13, age: 65.6 ± 5.3 years). The sampled segments were all significantly larger than those of the controls. In the clinical profiles, the sum of the <i>Z</i> scores of the neck triangle nerves (cervical spinal nerves and vagus nerve) and of all nerves (cervical spinal nerves, vagus nerve, and median nerve at the wrist) significantly correlated with the familial amyloid polyneuropathy stage, onset of autonomic nervous system (ANS) symptoms, and autonomic symptom scores. On cardiac examinations, several ultrasonography and magnetic resonance imaging parameters (primarily those that reflect heart volume) were found to be significantly correlated with the sum of the <i>Z</i> scores of the cervical spinal nerves but not with the <i>Z</i> score of the vagus nerve. In gastrointestinal evaluation, the cross-sectional area of the vagus nerve was correlated with gastric emptying time parameters on scintigraphy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Neck triangle nerve enlargement on sonography correlated with parameters related to ANS dysfunction, indicating that nerve enlargement observed on ultrasonography may serve as a potential surrogate biomarker of ATTRv.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"495-509"},"PeriodicalIF":9.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142454306","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":"Romosozumab versus denosumab in long-term users of glucocorticoids: A pilot randomized controlled trial","authors":"Chi Chiu Mok,&nbsp;Kar Li Chan,&nbsp;Sau Mei Tse,&nbsp;Sammy Pak Lam Chen,&nbsp;Kathryn Choon Beng Tan,&nbsp;Wai Han Ma","doi":"10.1111/joim.20017","DOIUrl":"10.1111/joim.20017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the efficacy of romosozumab (ROMO) and denosumab (DEN) in prevalent long-term glucocorticoid (GC) users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients receiving oral prednisolone (≥5 mg/day) with high risk of fracture were randomized to receive subcutaneous ROMO (210 mg monthly) or DEN (60 mg 6-monthly) for 12 months, followed by DEN for two more doses. The primary end point was the change in spine bone mineral density (BMD) from Months 0 to 12. Secondary end points included changes in BMD of the spine/hip/femoral neck and bone turnover markers at various time points and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy patients (age 62.6 ± 9.1 years; 96% women; median prednisolone dose 5.0 mg/day; duration of therapy 10.7 ± 7.4 years) were enrolled, and 63 completed the study. At Month 12, the spine BMD increased significantly in both ROMO (+7.3% ± 4.5%; <i>p</i> &lt; 0.001) and DEN (+2.3% ± 3.1%; <i>p</i> &lt; 0.001) groups. The absolute spine BMD gain from Months 0 to 12 was significantly greater in ROMO-treated patients (<i>p</i> &lt; 0.001). Although the total hip BMD at Month 12 also increased significantly in the ROMO (+1.6% ± 3.3%; <i>p</i> = 0.01) and DEN groups (+1.6% ± 2.6%; <i>p</i> = 0.003), the absolute BMD gain was not significantly different between the groups. At Month 24, the spine BMD continued to increase in both the ROMO (+9.7% ± 4.8%; <i>p</i> &lt; 0.001) and DEN group (+3.0% ± 3.0%; <i>p</i> &lt; 0.001) compared to baseline, and the absolute BMD gain remained significantly greater in ROMO-treated patients. The total hip BMD continued to increase in both groups (ROMO +2.9% ± 3.7%; <i>p</i> &lt; 0.001; DEN +2.2% ± 3.4%; <i>p</i> = 0.001), but the changes from baseline were similar. Injection site reaction was more frequently reported in ROMO-treated patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ROMO was superior to DEN in raising the spine BMD at Month 12 in chronic GC users. After switching to DEN, ROMO-treated patients continued to gain spine BMD to a greater extent than DEN until Month 24.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"481-494"},"PeriodicalIF":9.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142454307","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":"Pyridoxal-5′-phosphate: A cost-effective treatment candidate for hypertensive patients?","authors":"Michaela Lellig,&nbsp;Mariano Rodríguez,&nbsp;Rodrigo López-Baltanás,&nbsp;Juliane Hermann,&nbsp;Julia Wollenhaupt,&nbsp;Heidi Noels,&nbsp;Walter Zidek,&nbsp;Martin Tepel,&nbsp;Felix Mahfoud,&nbsp;Joachim Jankowski,&nbsp;Juan R. Muñoz-Castañeda,&nbsp;Vera Jankowski","doi":"10.1111/joim.20015","DOIUrl":"10.1111/joim.20015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Because angiotensin (Ang) II is an essential vasoconstrictive peptide, we analyzed the impact of its post-translational modification to pyruvamide–Ang II (Ang P) by pyridoxal-5′-phosphate (PLP) on blood pressure. PLP is a less expensive vitamin B₆ derivative and, therefore, could be a cost-effective drug against hypertension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Effect of Ang P on calcium ion entry into vascular smooth muscle cells (VSMCs) was analyzed. Binding affinity of Ang P to angiotensin II type 1 receptor (AT₁R) was measured. Vasoconstrictive effect of Ang P was investigated using the bioassay of isolated perfused rat kidneys. Spontaneously hypertensive rats (SHR) were administered PLP. Additionally, Wistar Kyoto rats (WKY) received Ang II and PLP. Blood pressure was measured time-dependently.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ang II, incubated with PLP, was post-translationally modified to Ang P. Calcium ion entry in VSMCs was significantly lower with Ang P compared to Ang II. Binding affinity of Ang P to AT₁R was lower compared to Ang II. Perfusion pressure of isolated perfused rat kidneys increased less by Ang P than by Ang II. Blood pressure of SHR treated with PLP decreased significantly. Blood pressure of WKY rats treated with Ang II was increased to hypertensive values, whereas blood pressure of WKY rats cotreated with Ang II and PLP was not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PLP induces a post-translational modification of Ang II decreasing blood pressure in rats. Assuming that increased PLP intake in the form of vitamin B₆ might reduce blood pressure in hypertensive patients, PLP might be a cost-effective drug against hypertension.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 5","pages":"435-448"},"PeriodicalIF":9.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142386777","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":"Depression and risk of stroke and mortality after percutaneous coronary intervention: A nationwide population study","authors":"Dae Young Cheon,&nbsp;Yong-Moon Park,&nbsp;Myung Soo Park,&nbsp;Jae Hyuk Choi,&nbsp;Mi-Sun Oh,&nbsp;Seongwoo Han,&nbsp;Kyung-Ho Yu,&nbsp;Byung-Chul Lee,&nbsp;Kyungdo Han,&nbsp;Minwoo Lee","doi":"10.1111/joim.20018","DOIUrl":"10.1111/joim.20018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Limited evidence exists on the role of depression in the risk of developing stroke and other cardiovascular outcomes in patients who have undergone percutaneous coronary interventions (PCI). We investigated this relationship with data from the Korean National Health Insurance Service database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our nationwide retrospective cohort study included 164,198 patients who had undergone PCI between 2010 and 2017. Depression was defined with the ICD-10 codes recorded prior to the PCI. The primary outcome was a new-onset stroke following the PCI. Secondary outcomes included PCI with myocardial infarction (MI), revascularization (PCI or coronary artery bypass grafting), and all-cause mortality. A multivariable Cox proportional hazards regression analysis was used to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI), adjusting for potential confounders, including sociodemographic and lifestyle factors, comorbidities, and MI at the index PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a median follow-up of 5.0 years, acute stroke occurred in 5.7% of patients with pre-existing depression (17.4% of the study population), compared to 3.5% of those without depression. Depression was associated with a 27% increased risk of acute stroke (aHR 1.27, 95% CI 1.20–1.35). Additionally, depression was linked with a 25% elevated risk of all-cause death (aHR 1.25, 95% CI, 1.21–1.29) and an 8% increased risk of revascularization (aHR 1.08, 95% CI 1.04–1.11). The associations with the risk of stroke and all-cause mortality were stronger in patients under 65 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that pre-existing depression may increase the risk of stroke and all-cause mortality following PCI, particularly in patients under 65 years. Additionally, depression was significantly associated with an increased need for revascularization. This underscores the potential benefits of managing depression to reduce stroke risk and overall cardiovascular outcomes following PCI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"468-480"},"PeriodicalIF":9.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379585","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":"Delirium and frailty in older adults: Clinical overlap and biological underpinnings","authors":"Giuseppe Bellelli,&nbsp;Federico Triolo,&nbsp;Maria Cristina Ferrara,&nbsp;Stacie G. Deiner,&nbsp;Alessandro Morandi,&nbsp;Matteo Cesari,&nbsp;Daniel Davis,&nbsp;Alessandra Marengoni,&nbsp;Marco Inzitari,&nbsp;Leiv Otto Watne,&nbsp;Kenneth Rockwood,&nbsp;Davide Liborio Vetrano","doi":"10.1111/joim.20014","DOIUrl":"10.1111/joim.20014","url":null,"abstract":"<p>Frailty and delirium are two common geriatric syndromes sharing several clinical characteristics, risk factors, and negative outcomes. Understanding their interdependency is crucial to identify shared mechanisms and implement initiatives to reduce the associated burden. This literature review summarizes scientific evidence on the complex interplay between frailty and delirium; clinical, epidemiological, and pathophysiological commonalities; and current knowledge gaps. We conducted a PubMed systematic search in June 2023, which yielded 118 eligible articles out of 991. The synthesis of the results—carried out by content experts—highlights overlapping risk factors, clinical phenotypes, and outcomes and explores the influence of one syndrome on the onset of the other. Common pathophysiological mechanisms identified include inflammation, neurodegeneration, metabolic insufficiency, and vascular burden. The review suggests that frailty is a risk factor for delirium, with some support for delirium associated with accelerated frailty. The proposed unifying framework supports the integration and measurement of both constructs in research and clinical practice, identifying the geroscience approach as a potential avenue to develop strategies for both conditions. In conclusion, we suggest that frailty and delirium might be alternative—sometimes coexisting—manifestations of accelerated biological aging. Clinically, the concepts addressed in this review can help approach older adults with either frailty or delirium from a different perspective. From a research standpoint, longitudinal studies are needed to explore the hypothesis that specific pathways within the biology of aging may underlie the clinical manifestations of frailty and delirium. Such research will pave the way for future understanding of other geriatric syndromes as well.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 5","pages":"382-398"},"PeriodicalIF":9.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337986","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}