QJM: An International Journal of Medicine最新文献

{"title":"Mikulicz Syndrome.","authors":"Timor Linder, Naiel Bisharat","doi":"10.1093/qjmed/hcag280","DOIUrl":"https://doi.org/10.1093/qjmed/hcag280","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":"149171626","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":"Deconstructing the Modified Sequential Organ Failure Assessment (mSOFA) Score: A Decision Tree Analysis Reveals the Pathophysiological Hierarchy of Organ Dysfunction Predictors in Prehospital Critical Care.","authors":"Alberto López Ballesteros, Erik Alonso, Iraia Isasi, Asier Losada, Samantha Díaz-González, Sergio Rodriguez-Cañamero, José Luis Martín-Conty, Begoña Polonio-López, Carlos Del Pozo-Vegas, Raúl López-Izquierdo, Francisco Martín-Rodríguez, Ancor Sanz-García","doi":"10.1093/qjmed/hcag287","DOIUrl":"https://doi.org/10.1093/qjmed/hcag287","url":null,"abstract":"<p><strong>Background: </strong>Early recognition of multiple organ dysfunction syndrome (MODS) in the prehospital setting remains challenging and is critical for reducing mortality among critically ill patients. The modified Sequential Organ Failure Assessment (mSOFA) score was developed for prehospital use with point-of-care testing; however, the internal decision architecture of this score remains unexplored.</p><p><strong>Methods: </strong>A prospective, multicentre, observational study was conducted across three emergency medical systems (EMS) in Spain, included adults (n = 12,212) with acute illness transferred to emergency departments with high priority. A decision tree (DT) model was developed using the five components of the mSOFA score, lactate, Glasgow Coma Scale (GCS), oxygen saturation-to-fraction of inspired oxygen ratio (SaFi), mean blood pressure (MBP), and creatinine, to predict in-hospital mortality at 2 days. The study followed the STROBE and TRIPOD+AI guidelines.</p><p><strong>Results: </strong>Cohort mortality was 5.0% (n = 609). Lactate emerged as the primary decision variable, with a threshold of 3.8 mmol/L, followed by SaFi, GCS, and creatinine in patients with hyperlactataemia, and by GCS and creatinine when lactate was below the threshold.</p><p><strong>Conclusions: </strong>The DT deconstructs the mSOFA from a static score into a dynamic, interpretable clinical decision framework. By revealing the pathophysiological hierarchy underlying the score, with lactate as the central stratification axis, this approach enables EMS clinicians to identify distinct clinical phenotypes and anticipate deterioration based on the sequential evaluation of organ dysfunction rather than a single numerical threshold.</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":"149170314","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":"Extrachromosomal DNA: drivers of tumor heterogeneity and evolution.","authors":"Siwen Zhao, Enwu Xu, Jirong Jie, Chao Su, Yanyi You, Ziqing Jiang, Xiaohui Wen, Fengying Gong, Ying Lv, Ying Liu, Fei Li, Qin Fan, Daoqi Zhu","doi":"10.1093/qjmed/hcag285","DOIUrl":"https://doi.org/10.1093/qjmed/hcag285","url":null,"abstract":"<p><strong>Background: </strong>Extrachromosomal DNA (ecDNA) is a key structural variant in cancer genomes, recently identified as a crucial driver of tumor heterogeneity and evolution.</p><p><strong>Aim: </strong>This review aims to summarize the molecular characteristics of ecDNA and elucidate the mechanisms by which it influences tumor evolution and heterogeneity.</p><p><strong>Design: </strong>Narrative review.</p><p><strong>Methods: </strong>We conducted a literature search on the formation, function, and clinical implications of ecDNA using PubMed and other relevant databases.</p><p><strong>Results: </strong>ecDNA is prevalent in highly invasive tumors and enhances oncogene expression by forming multifunctional transcriptional hubs. Its random mitotic distribution generates high intra-tumoral copy number heterogeneity, allowing cells to dynamically regulate oncogene expression and rapidly adapt to selective pressures.</p><p><strong>Conclusions: </strong>ecDNA offers a novel perspective on tumor resistance mechanisms. Targeting ecDNA formation and regulatory networks holds promise for developing new combination therapies and biomarkers for malignant tumors.</p>","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228641","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":"Amyloid goitre in cryptogenic AA amyloidosis: contrasting thyroid phenotypes and proteomic typing.","authors":"Aparna Hari, Neeraj Sidharthan, Monisha Harimadhavan, Praveen V P, Smitha N V, R Rajesh Kannan, Shanmugha Sundaram P, Sreenidhi V M, Hisham Ahamed","doi":"10.1093/qjmed/hcag290","DOIUrl":"https://doi.org/10.1093/qjmed/hcag290","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170065","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":"Unmasking Osteonecrosis: A Hidden Complication of Transfusion-Dependent β-Thalassemia Major: A Case Report.","authors":"Fatima Alzahraa Alhaj Akeel, Simple Sibi Joseph, Huda Elnaiem Elmahdi, Abdelkarim Alammora, Wanis Ibrahim","doi":"10.1093/qjmed/hcag292","DOIUrl":"https://doi.org/10.1093/qjmed/hcag292","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168917","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":"Interpreting Respiratory Viral Risk with Benralizumab: From Treatment Assignment to Eosinophil Depletion.","authors":"Miao-Sha Hsu, Chen Dong","doi":"10.1093/qjmed/hcag294","DOIUrl":"https://doi.org/10.1093/qjmed/hcag294","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167508","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":"Pencil in Cup Change in Destructive Psoriatic Hand Arthropathy.","authors":"Bodhibrata Banerjee, Sanjay Jain, Shefali Khanna Sharma","doi":"10.1093/qjmed/hcag288","DOIUrl":"https://doi.org/10.1093/qjmed/hcag288","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147784","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":"Repeated red-cell auto-agglutination on peripheral smear: A clue to cold agglutinin disease presenting with rapidly progressive multifocal digital gangrene.","authors":"Sourav Garai, Ritasman Baisya, Sukdev Manna","doi":"10.1093/qjmed/hcag286","DOIUrl":"https://doi.org/10.1093/qjmed/hcag286","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138086","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":"Does lifestyle modify the association between relative handgrip strength and cancer risk?","authors":"Hua Xiao, Bin Bai","doi":"10.1093/qjmed/hcag281","DOIUrl":"https://doi.org/10.1093/qjmed/hcag281","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138137","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":"Response to \"Does lifestyle modify the association between relative handgrip strength and cancer risk?\"","authors":"Yanxue Lian, Pincheng Luo","doi":"10.1093/qjmed/hcag284","DOIUrl":"https://doi.org/10.1093/qjmed/hcag284","url":null,"abstract":"","PeriodicalId":20806,"journal":{"name":"QJM: An International Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138065","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}