QJM: An International Journal of Medicine最新文献

{"title":"Electrocardiographic Clues to Digoxin Toxicity in Chronic Kidney Disease.","authors":"Myoung-Joon Lee, Yun-Tao Zhao","doi":"10.1093/qjmed/hcag298","DOIUrl":"https://doi.org/10.1093/qjmed/hcag298","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart failure in severe mental illness: an inequality hiding in plain sight.","authors":"Gracie Tredget, Siobhan Gee, Fiona Gaughran, Jessica Webb","doi":"10.1093/qjmed/hcag301","DOIUrl":"https://doi.org/10.1093/qjmed/hcag301","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precordial Swirl Sign: A Subtle ECG Clue Unmasking Anterior Myocardial Ischemia.","authors":"Myoung-Joon Lee, Mingjie Zhong, Yun-Tao Zhao","doi":"10.1093/qjmed/hcag302","DOIUrl":"https://doi.org/10.1093/qjmed/hcag302","url":null,"abstract":"<p><p>Precordial swirl sign may provide a clue to anterior myocardial ischemia in patients whose electrocardiograms do not meet conventional ST-segment elevation myocardial infarction criteria. A 75-year-old man with previous coronary stenting presented with worsening chest pain and an initially negative troponin result. His admission electrocardiogram showed focal ST-segment elevation in V1, a hyperacute T wave in V2, and reciprocal ST-segment depression in V5-V6. Subsequent anterior Twave inversion and troponin elevation supported an ischemic interpretation. Coronary angiography revealed approximately 90% proximal left anterior descending coronary artery in-stent restenosis with TIMI 2 flow. Balloon angioplasty followed by drug-coated balloon treatment restored TIMI 3 flow. This case illustrates the importance of interpreting opposing precordial ST-T changes in relation to the ischemic vector rather than considering ST-segment elevation thresholds alone. Recognition of this pattern may prompt serial electrocardiography, repeat biomarker testing, and timely assessment for coronary intervention.</p>","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149246156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competing Risks Considerations in Trends of Cause-Specific Mortality Among UK Dialysis Patients.","authors":"Hefziba Lorences Noguera, Esteban Cardenas-Duran","doi":"10.1093/qjmed/hcag258","DOIUrl":"https://doi.org/10.1093/qjmed/hcag258","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in mortality of people with kidney failure starting dialysis in England and Wales.","authors":"Andrew Davenport, Steenkamp Retha, Nitsch Dorothea","doi":"10.1093/qjmed/hcag229","DOIUrl":"https://doi.org/10.1093/qjmed/hcag229","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in mortality of people starting dialysis in England and Wales over the last 15 years.","authors":"Andrew Davenport, Retha Steenkamp, Dorothea Nitsch","doi":"10.1093/qjmed/hcag263","DOIUrl":"https://doi.org/10.1093/qjmed/hcag263","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intention-to-Treat Reporting in a Probiotic Trial for Eczema Prevention.","authors":"Ercan Yılmaz","doi":"10.1093/qjmed/hcag293","DOIUrl":"https://doi.org/10.1093/qjmed/hcag293","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The GP Crisis Dissected: An Outsider's View.","authors":"Ami Schattner","doi":"10.1093/qjmed/hcag283","DOIUrl":"https://doi.org/10.1093/qjmed/hcag283","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable Machine Learning Model for Personalized Assessment of the Need for Intensive Care in Patients with Myasthenia Gravis Based on Phenotype and Inflammatory Markers.","authors":"Che-Cheng Chang, Kuan-Yu Lin, Jiann-Horng Yeh, Hou-Chang Chiu, Tzu-Chi Liu, Chi-Jie Lu","doi":"10.1093/qjmed/hcag289","DOIUrl":"https://doi.org/10.1093/qjmed/hcag289","url":null,"abstract":"<p><strong>Background: </strong>Early identification of myasthenia gravis (MG) severe exacerbations that require intensive care unit (ICU) admission remains challenging due disease highly heterogeneous. Existing models seldom incorporate phenotype stratification, limiting interpretability and clinical utility.</p><p><strong>Aim: </strong>This study aimed to develop an explainable machine learning (ML) model to assess phenotype-specific risk factors and predict ICU admission for patients with MG.</p><p><strong>Design and methods: </strong>This retrospective study included 319 hospitalized patients with MG. We utilized clinical variables and systemic inflammation markers for ML modeling. Subgroups were prespecified by thymoma status and age at onset. Primary outcome was need for intensive care during the hospitalization. Model performance was assessed. SHapley Additive exPlanations (SHAP) was employed for interpretation of global and individual features.</p><p><strong>Results: </strong>Of 319 admissions, 33 (10.3%) required ICU care. Four ML models were trained with nested 3-fold validation. eXtreme Gradient Boosting performed best (AUC: 0.94). SHAP ranked MGFA clinical classification, infection during admission, body mass index, and inflammatory indices as principal predictors. Subgroup analyses revealed phenotype-specific patterns, including opposite SHAP directions for inflammatory markers between thymoma and non-thymoma groups and distinct rankings between different age of onset groups. SHAP-based personalized explanations revealed patient-specific variations in risk ranking and directionality of predictive features. A web-based calculator was developed to support real-time clinical implementation of the model, potentially allowing for risk stratification.</p><p><strong>Conclusions: </strong>An explainable machine learning framework that integrates clinical features with systemic inflammation indices reliably predicts ICU admission in MG and reveals phenotype-specific risk patterns, enabling personalized risk stratification in MG management.</p>","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Period-Cohort Confounding in a Two-Decade Comparison of Healthy Life Expectancy Among China's Oldest-Old.","authors":"Hefziba Lorences Noguera, Esteban Cardenas Duran","doi":"10.1093/qjmed/hcag291","DOIUrl":"https://doi.org/10.1093/qjmed/hcag291","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}