Journal of Internal Medicine最新文献

{"title":"Reframing prediabetes: A call for better risk stratification and intervention","authors":"Sun H. Kim","doi":"10.1111/joim.13786","DOIUrl":"10.1111/joim.13786","url":null,"abstract":"<p>Prediabetes is an intermediate state of glucose homeostasis whereby plasma glucose concentrations are above normal but below the threshold of diagnosis for diabetes. Over the last several decades, criteria for prediabetes have changed as the cut points for normal glucose concentration and diagnosis of diabetes have shifted. Global consensus does not exist for prediabetes criteria; as a result, the clinical course and risk for type 2 diabetes vary. At present, we can identify individuals with prediabetes based on three glycemic tests (hemoglobin A1c, fasting plasma glucose, and 2-h plasma glucose during an oral glucose tolerance test). The majority of individuals diagnosed with prediabetes meet only one of these criteria. Meeting one, two, or all glycemic criteria changes risk for type 2 diabetes, but this information is not widely known and does not currently guide intervention strategies for individuals with prediabetes. This review summarizes current epidemiology, prognosis, and intervention strategies for individuals diagnosed with prediabetes and suggests a call for more precise risk stratification of individuals with prediabetes as elevated (one prediabetes criterion), high risk (two prediabetes criteria), and very high risk (three prediabetes criteria). In addition, the roles of oral glucose tolerance testing and continuous glucose monitoring in the diagnostic criteria for prediabetes need reassessment. Finally, we must reframe our goals for prediabetes and prioritize intensive interventions for those at high and very high risk for type 2 diabetes.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"295 6","pages":"735-747"},"PeriodicalIF":11.1,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13786","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140595202","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":"Bilateral inferior petrosal sinus sampling in the differential diagnosis of ACTH-dependent Cushing's syndrome: A reappraisal","authors":"Majid Valizadeh,&nbsp;Behnaz Abiri,&nbsp;Farhad Hosseinpanah,&nbsp;Ashley Grossman","doi":"10.1111/joim.13789","DOIUrl":"10.1111/joim.13789","url":null,"abstract":"<p>Cushing's syndrome (CS) is a rare disorder, once exogenous causes have been excluded. However, when diagnosed, the majority of cases are adrenocorticotropic hormone (ACTH)-dependent, of which a substantial minority are due to a source outside of the pituitary, ectopic ACTH syndrome (EAS). Differentiating among pituitary-dependent CS, Cushing's disease (CD) and an ectopic source can be problematic. Because non-invasive tests in the evaluation of CS patients often lack adequate sensitivity and specificity, bilateral inferior petrosal sinus sampling (BIPSS), a minimally invasive procedure performed during the investigation of ACTH-dependent CS, can be extremely helpful. BIPSS is considered to be the gold standard for differentiating CD from the EAS. Furthermore, although such differentiation may indeed be challenging, BIPSS is itself a complex investigation, especially in recent times due to the widespread withdrawal of corticotrophin-releasing hormone and its replacement by desmopressin. We review current published data on this investigation and, in the light of this and our own experience, discuss its appropriate use in diagnostic algorithms.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 1","pages":"2-23"},"PeriodicalIF":11.1,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13789","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140595143","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":"The gratitude paradox","authors":"Marie Chisholm-Burns,&nbsp;Richard N. Formica","doi":"10.1111/joim.13788","DOIUrl":"10.1111/joim.13788","url":null,"abstract":"&lt;p&gt;In April 2023, the &lt;i&gt;New York Times&lt;/i&gt; published an opinion piece by author and heart transplant patient, Amy Silverstein [&lt;span&gt;1&lt;/span&gt;]. Ms. Silverstein's perspective provoked an array of responses, some of which were angry because of the perception that she lacked gratitude for the second and third chance at life she was given. However, as professionals in the transplant field, Ms. Silverstein's story resonated with us, particularly her description of what she called the “gratitude paradox” wherein solid-organ transplant patients are expected to be grateful for what they have—a new, functioning organ—and are either implicitly or explicitly discouraged from asking for more and better posttransplant treatment options [&lt;span&gt;1&lt;/span&gt;]. While her observations were personal for us, we see parallels that are relevant for the entire healthcare community. Ms. Silverstein pointed to the conflicting emotions of her own gratitude for her two heart transplants in the wake of her terminal cancer diagnosis, a diagnosis she states likely resulted from long-term use of immunosuppression medications meant to preserve her transplanted organ, and her desire to have more life. She wasn't ungrateful in expressing that desire; she was simply being human. While the specifics of Ms. Silverstein's life are relevant to the field of transplantation, we believe the human desires she expressed should cause the entire healthcare community to pause and reflect about why we chose this calling and our inherent responsibilities.&lt;/p&gt;&lt;p&gt;The concept of the gratitude paradox is not new. The BBC correspondent Kate Morgan explored this issue in a 2021 piece examining the complexities of gratitude for being employed in the wake of the COVID-19 pandemic [&lt;span&gt;2&lt;/span&gt;]. She discussed the dilemma many individuals experienced between being grateful to have a job during a time of rising unemployment and feeling underpaid, undervalued, and overburdened by employers [&lt;span&gt;2&lt;/span&gt;]. Another, more historical example is the “separate but equal” laws, colloquially known as Jim Crow laws, that pervaded American life in the post-Civil War era through the Civil Rights movement of the 1960s. Under Jim Crow, Black Americans experienced and were expected to be grateful for (or as Davis [&lt;span&gt;3&lt;/span&gt;] describes, “agreeable and non-challenging”), segregated conditions that proved to be anything but equal. There is a prevailing attitude that certain populations, in particular those who are vulnerable, such as patients with chronic medical conditions, racial and ethnic minority groups, or individuals from poorer socioeconomic backgrounds, should be thankful for whatever benefits of progress made in achieving a better life. They are viewed as troublemakers who lack gratitude whenever they suggest the bare minimum is not enough.&lt;/p&gt;&lt;p&gt;In our society, there is an expectation that disadvantaged and vulnerable populations should be grateful for having something that is one step above having nothin","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"295 6","pages":"712-714"},"PeriodicalIF":11.1,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13788","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140595152","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":"Impact of nutritional support routes on mortality in acute pancreatitis: A network meta-analysis of randomized controlled trials","authors":"Ping-Han Hsieh,&nbsp;Tsung-Chieh Yang,&nbsp;Enoch Yi-No Kang,&nbsp;Pei-Chang Lee,&nbsp;Jiing-Chyuan Luo,&nbsp;Yi-Hsiang Huang,&nbsp;Ming-Chih Hou,&nbsp;Shih-Ping Huang","doi":"10.1111/joim.13782","DOIUrl":"10.1111/joim.13782","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nutritional administration in acute pancreatitis (AP) management has sparked widespread discussion, yet contradictory mortality results across meta-analyses necessitate clarification. The optimal nutritional route in AP remains uncertain. Therefore, this study aimed to compare mortality among nutritional administration routes in patients with AP using consistency model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study searched four major databases for relevant randomized controlled trials (RCTs). Two authors independently extracted and checked data and quality. Network meta-analysis was conducted for estimating risk ratios (RRs) with 95% confidence interval (CI) based on random-effects model. Subgroup analyses accounted for AP severity and nutrition support initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A meticulous search yielded 1185 references, with 30 records meeting inclusion criteria from 27 RCTs (<i>n</i> = 1594). Pooled analyses showed the mortality risk reduction associated with nasogastric (NG) (RR = 0.34; 95%CI: 0.16–0.73) and nasojejunal (NJ) feeding (RR = 0.46; 95%CI: 0.25–0.84) in comparison to nil per os. Similarly, NG (RR = 0.45; 95%CI: 0.24–0.83) and NJ (RR = 0.60; 95%CI: 0.40–0.90) feeding also showed lower mortality risk than total parenteral nutrition. Subgroup analyses, stratified by severity, supported these findings. Notably, the timing of nutritional support initiation emerged as a significant factor, with NJ feeding demonstrating notable mortality reduction within 24 and 48 h, particularly in severe cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For severe AP, both NG and NJ feeding appear optimal, with variations in initiation timings. NG feeding does not appear to merit recommendation within the initial 24 h, whereas NJ feeding is advisable within the corresponding timeframe following admission. These findings offer valuable insights for optimizing nutritional interventions in AP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"295 6","pages":"759-773"},"PeriodicalIF":11.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334066","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":"Escalated complement activation during hospitalization is associated with higher risk of 60-day mortality in SARS-CoV-2-infected patients","authors":"Andreas Barratt-Due,&nbsp;Kristin Pettersen,&nbsp;Tuva Børresdatter-Dahl,&nbsp;Jan Cato Holter,&nbsp;Renathe H. Grønli,&nbsp;Anne Ma Dyrhol-Riise,&nbsp;Tøri Vigeland Lerum,&nbsp;Aleksander Rygh Holten,&nbsp;Kristian Tonby,&nbsp;Marius Trøseid,&nbsp;Ole H. Skjønsberg,&nbsp;Beathe Kiland Granerud,&nbsp;Lars Heggelund,&nbsp;Anders Benjamin Kildal,&nbsp;Camilla Schjalm,&nbsp;Trond Mogens Aaløkken,&nbsp;Pål Aukrust,&nbsp;Thor Ueland,&nbsp;Tom Eirik Mollnes,&nbsp;Bente Halvorsen,&nbsp;NOR-Solidarity study groupThe Norwegian SARS-CoV-2 study group","doi":"10.1111/joim.13783","DOIUrl":"10.1111/joim.13783","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The complement system, an upstream recognition system of innate immunity, is activated upon SARS-CoV-2 infection. To gain a deeper understanding of the extent and duration of this activation, we investigated complement activation profiles during the acute phase of COVID-19, its persistence post-recovery and dynamic changes in relation to disease severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Serial blood samples were obtained from two cohorts of hospitalized COVID-19 patients (<i>n</i> = 457). Systemic complement activation products reflecting classical/lectin (C4d), alternative (C3bBbP), common (C3bc) and terminal pathway (TCC and C5a) were measured during hospitalization (admission, days 3–5 and days 7–10), at 3 months and after 1 year. Levels of activation and temporal profiles during hospitalization were related to disease severity defined as respiratory failure (PO₂/FiO₂ ratio &lt;26.6 kPa) and/or admission to intensive care unit, 60-day total mortality and pulmonary pathology after 3 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>During hospitalization, TCC, C4d, C3bc, C3bBbP and C5a were significantly elevated compared to healthy controls. Severely ill patients had significantly higher levels of TCC and C4d (<i>p </i>&lt; 0.001), compared to patients with moderate COVID-19. Escalated levels of TCC and C4d during hospitalization were associated with a higher risk of 60-day mortality (<i>p </i>&lt; 0.001), and C4d levels were additionally associated with chest CT changes at 3 months (<i>p </i>&lt; 0.001). At 3 months and 1 year, we observed consistently elevated levels of most complement activation products compared to controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hospitalized COVID-19 patients display prominent and long-lasting systemic complement activation. Optimal targeting of the system may be achieved through enhanced risk stratification and closer monitoring of in-hospital changes of complement activation products.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 1","pages":"80-92"},"PeriodicalIF":11.1,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13783","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304208","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":"Association of hospital-treated infectious diseases and infection burden with cardiovascular diseases and life expectancy","authors":"Jiazhen Zheng,&nbsp;Can Ni,&nbsp;S. W. Ricky Lee,&nbsp;Fu-Rong Li,&nbsp;Jinghan Huang,&nbsp;Rui Zhou,&nbsp;Yining Huang,&nbsp;Gregory Y. H. Lip,&nbsp;Xianbo Wu,&nbsp;Shaojun Tang","doi":"10.1111/joim.13780","DOIUrl":"10.1111/joim.13780","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The association of a broad spectrum of infectious diseases with cardiovascular outcomes remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aim to provide the cardiovascular risk profiles associated with a wide range of infectious diseases and explore the extent to which infections reduce life expectancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We ascertained exposure to 900+ infectious diseases before cardiovascular disease (CVD) onset in 453,102 participants from the UK Biobank study. Time-varying Cox proportional hazard models were used. Life table was used to estimate the life expectancy of individuals aged ≥50 with different levels of infection burden (defined as the number of infection episodes over time and the number of co-occurring infections).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Infectious diseases were associated with a greater risk of CVD events (adjusted HR [aHR] 1.79 [95% confidence interval {CI} 1.74–1.83]). For type-specific analysis, bacterial infection with sepsis had the strongest risk of CVD events [aHR 4.76 (4.35–5.20)]. For site-specific analysis, heart and circulation infections posed the greatest risk of CVD events [aHR 4.95 (95% CI 3.77–6.50)], whereas noncardiac infections also showed excess risk [1.77 (1.72–1.81)]. Synergistic interactions were observed between infections and genetic risk score. A dose–response relationship was found between infection burden and CVD risks (<i>p</i>-trend &lt;0.001). Infection burden &gt;1 led to a CVD-related life loss at age 50 by 9.3 years [95% CI 8.6–10.3]) for men and 6.6 years [5.5–7.8] for women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The magnitude of the infection-CVD association showed specificity in sex, pathogen type, infection burden, and infection site. High genetic risk and infection synergistically increased the CVD risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"295 5","pages":"679-694"},"PeriodicalIF":11.1,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287819","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":"Serum T50 predicts cardiovascular mortality in individuals with type 2 diabetes: A prospective cohort study","authors":"Amarens van der Vaart,&nbsp;Coby Eelderink,&nbsp;Harry van Goor,&nbsp;Jan-Luuk Hillebrands,&nbsp;Charlotte A. te Velde-Keyzer,&nbsp;Stephan J.L. Bakker,&nbsp;Andreas Pasch,&nbsp;Peter R. van Dijk,&nbsp;Gozewijn D. Laverman,&nbsp;Martin H. de Borst","doi":"10.1111/joim.13781","DOIUrl":"10.1111/joim.13781","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Individuals with type 2 diabetes (T2D) have a higher risk of cardiovascular disease, compared with those without T2D. The serum T50 test captures the transformation time of calciprotein particles in serum. We aimed to assess whether serum T50 predicts cardiovascular mortality in T2D patients, independent of traditional risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 621 individuals with T2D in this prospective cohort study. Cox regression models were performed to test the association between serum T50 and cardiovascular and all-cause mortality. Causes of death were categorized according to ICD-10 codes. Risk prediction improvement was assessed by comparing Harrell's C for models without and with T_50.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 64.2 ± 9.8 years, and 61% were male. The average serum T50 time was 323 ± 63 min. Higher age, alcohol use, high-sensitive C-reactive protein, and plasma phosphate were associated with lower serum T₅₀ levels. Higher plasma triglycerides, venous bicarbonate, sodium, magnesium, and alanine aminotransferase were associated with higher serum T50 levels. After a follow-up of 7.5[5.4–10.7] years, each 60 min decrease in serum T50 was associated with an increased risk of cardiovascular (fully adjusted HR 1.32, 95% CI 1.08–1.50, and <i>p</i> = 0.01) and all-cause mortality (HR 1.15, 95%CI 1.00–1.38, and <i>p</i> = 0.04). Results were consistent in sensitivity analyses after exclusion of individuals with estimated glomerular filtration rate &lt;45 or &lt;60 mL/min/1.73 m² and higher plasma phosphate levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Serum T50 improves prediction of cardiovascular and all-cause mortality risk in individuals with T2D. Serum T50 may be useful for risk stratification and to guide therapeutic strategies aiming to reduce cardiovascular mortality in T2D.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"295 6","pages":"748-758"},"PeriodicalIF":11.1,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13781","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287820","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":"Infertility treatment and cardiovascular disease: What do we know?","authors":"Peter Henriksson","doi":"10.1111/joim.13779","DOIUrl":"10.1111/joim.13779","url":null,"abstract":"&lt;p&gt;At present, the dominating modality of assisted reproductive technology (ART) is in vitro fertilization (IVF). This treatment was introduced in 1978 with the birth of Louise Joy Brown in the United Kingdom [&lt;span&gt;1&lt;/span&gt;]. The field of ART has ever since expanded, and today, more than 10 million children have been born as a result of IVF [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;About a third of embryo transfers after IVF result in a clinical pregnancy, and a fourth in a live-born child [&lt;span&gt;3&lt;/span&gt;]. This results in an annual increase of half a million children born after IVF as the result of 2 million annual embryo transfers. The remaining embryos are, in most cases, cryopreserved and available for future embryo transfers [&lt;span&gt;4&lt;/span&gt;]. Use of frozen and thawed embryo transfers (FET) was previously considered to lead to fewer successful pregnancies as compared to fresh embryo transfers, but technical advances, such as innovative freezing techniques, vitrification and visual embryo selection of embryos or blastocysts, have improved the success rate of FET to a level on par with that of fresh embryo transfers [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The risk of venous thromboembolism (VTE), including pulmonary embolism (PE), is increased in women during pregnancy [&lt;span&gt;6&lt;/span&gt;]. The incidence is most pronounced during the third trimester of pregnancy and in the immediate postpartum period. The mortality rate in pregnant women afflicted by VTE has been estimated to be between 0.8 and 1.5 per 100,000 pregnancies, with more than 90% of fatal VTEs being due to PE.&lt;/p&gt;&lt;p&gt;IVF results in a more than eightfold increase in both VTEs and PEs during the first trimester of fresh embryo transfer pregnancies [&lt;span&gt;7&lt;/span&gt;]. There was no such increase in the incidence of VTEs and PEs after FET/thawed embryo transfer pregnancies [&lt;span&gt;8&lt;/span&gt;]. This indicates that ovarian stimulation, with its oestrogen surge, seems to be a necessary prerequisite to trigger the increase in VTEs and PEs.&lt;/p&gt;&lt;p&gt;Furthermore, gestational hypertension and pre-eclampsia have been reported to increase during IVF pregnancies [&lt;span&gt;9&lt;/span&gt;]. A recent interesting observation suggests that this could be related to the absence of a corpus luteum in some pregnancies.&lt;/p&gt;&lt;p&gt;Concerning cardiovascular disease associated with unsuccessful IVF treatment – the majority of embryo transfers – there are conflicting reports. One study showed an increased incidence of PE after unsuccessful IVF, but on the contrary, another study showed a lower incidence of VTE after failed ART.&lt;/p&gt;&lt;p&gt;Furthermore, many women will experience multiple subsequent IVF cycles due to the fact that only a quarter of the embryo transfers result in a live-born child. The cardiovascular effect of multiple subsequent IVF cycles has not yet been studied.&lt;/p&gt;&lt;p&gt;There has been a paucity of studies concerning the long-term effects of IVF on cardiovascular health. The heterogeneity of the few pre-existing studies precluded any final conclusions, but a ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"295 5","pages":"580-582"},"PeriodicalIF":11.1,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13779","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140157184","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":"18th Key Symposium: Longevity and Healthy Ageing: What can we learn from Blue Zones?","authors":"","doi":"10.1111/joim.13730","DOIUrl":"10.1111/joim.13730","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"295 4","pages":"386"},"PeriodicalIF":11.1,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140130300","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":"Malignant ovarian and testicular germ cell tumors: Common characteristics but different prognoses","authors":"Camilla Sköld,&nbsp;Anna K Jansson,&nbsp;Ingrid Glimelius","doi":"10.1111/joim.13778","DOIUrl":"10.1111/joim.13778","url":null,"abstract":"<p>Both ovarian and testicular germ cell tumors (GCTs) arise from the primordial germ cell and share many similarities. Both malignancies affect mainly young patients, show remarkable responsiveness to cisplatin-based therapy, and have an excellent prognosis, which also highlights the importance of minimizing long-term side effects. However, certain differences can be noted: The spreading of the disease differs, and the staging system and treatment recommendations are dissimilar. Moreover, the prognosis for ovarian GCTs is significantly inferior to that for testicular cancer, as exemplified in this review comparing the survival in Swedish patients diagnosed with testicular (1995–2022) and ovarian (1990–2018) GCTs. The 5-year overall survival in ovarian GCTs was 85.2%, versus 98.2% for testicular GCTs. How can this be explained? One reason may be the difference in knowledge, experience, and evidence because the incidence rate of testicular cancer is more than 15 times that of ovarian GCTs. Given the rarity of the disease in women and the lack of established guidelines, a comprehensive understanding of the disease and treatment decisions is challenging. The main objective of this review is to derive insights from testicular GCTs (seminoma and non-seminoma) by reviewing etiological, tumor biological, and clinical knowledge, and to thereafter suggest actions for ovarian GCTs based on this. We hypothesize that by adopting specific treatment strategies from testicular GCTs—including de-escalating adjuvant chemotherapy for low-risk patients and implementing more standardized and intensive treatment protocols in cases of relapse—we can improve the prognosis and minimize long-term side effects in ovarian GCT patients.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"295 6","pages":"715-734"},"PeriodicalIF":11.1,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.13778","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140100579","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}