Annals of medicine最新文献

{"title":"Prophylactic effects of nutrition, dietary strategies, exercise, lifestyle and environment on nonalcoholic fatty liver disease.","authors":"Xiangyong Hao, Hao Song, Xin Su, Jian Li, Youbao Ye, Cailiu Wang, Xiao Xu, Guanglong Pang, Wenxiu Liu, Zihan Li, Tian Luo","doi":"10.1080/07853890.2025.2464223","DOIUrl":"10.1080/07853890.2025.2464223","url":null,"abstract":"<p><strong>Background: </strong>Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and its prevalence has risen sharply. However, whether nutrition, dietary strategies, exercise, lifestyle and environment have preventive value for NAFLD remains unclear.</p><p><strong>Methods: </strong>Through searching 4 databases (PubMed, Web of Science, Embase and the Cochrane Library) from inception to January 2025, we selected studies about nutrition, dietary strategies, exercise, lifestyle and environment in the prevention of NAFLD and conducted a narrative review on this topic.</p><p><strong>Results: </strong>Reasonable nutrient intake encompassing macronutrients and micronutrients have an independent protective relationship with NAFLD. Besides, proper dietary strategies including mediterranean diet, intermittent fasting diet, ketogenic diet, and dietary approaches to stop hypertension diet have their inhibitory effects on the developmental process of NAFLD. Moreover, right exercises including walking, jogging, bicycling, and swimming are recommended for the prevention of NAFLD because they could effectively reduce weight, which is an important risk factor for NAFLD, and improve liver function. In addition, embracing a healthy lifestyle including reducing sedentary behavior, not smoking, sleeping well and brushing teeth regularly is integral since it not only could reduce the risk of NAFLD but also significantly contribute to overall prevention and control. Finally, the environment, including the social and natural environments, plays a potential role in NAFLD prevention.</p><p><strong>Conclusion: </strong>Nutrition, dietary strategies, exercise, lifestyle and environment play an important role in the prevention of NAFLD. Moreover, this review offers comprehensive prevention recommendations for people at high risk of NAFLD.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2464223"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11827040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of pre-treatment and post-treatment plasma Epstein-Barr virus DNA in peripheral T-cell lymphomas.","authors":"Chu-Yi Chan, Tung-Liang Lin, Ming-Chung Kuo, Yu-Shin Hung, Hung Chang, Che-Wei Ou, Jin-Hou Wu, Hsuan-Jen Shih, Yi-Jiun Su, Lee-Yung Shih, Yuen-Chin Ong, Wen-Yu Chuang, Hsiao-Wen Kao","doi":"10.1080/07853890.2025.2478315","DOIUrl":"10.1080/07853890.2025.2478315","url":null,"abstract":"<p><strong>Background: </strong>Plasma Epstein-Barr virus (EBV) DNA levels predict the prognosis of extranodal NK/T-cell lymphoma, nasal type (NK/TCL), but its role in other peripheral T-cell lymphomas (PTCL) remains undetermined. This study aimed to determine the prognostic impact of plasma EBV DNA in PTCL patients.</p><p><strong>Methods: </strong>We retrospectively enrolled 134 PTCL patients diagnosed between April 2008 and March 2022, with plasma EBV DNA data available at diagnosis in 124 patients and during post-treatment follow-up in 73 patients.</p><p><strong>Results: </strong>International Prognostic Index or prognostic index for T-cell lymphoma scores > 1 was associated with higher median plasma EBV DNA levels in all analyzed patients. Plasma EBV DNA positivity at the time of diagnosis was not associated with treatment response, overall survival (OS), or progression-free survival (PFS) in non-NK/TCL patients. In NK/TCL patients, an EBV DNA level < 3255 copies/mL at diagnosis was significantly associated with higher five-year PFS (64.2% vs. 16.7%, <i>p</i> < 0.001) and OS rates (64.4% vs. 20.8%, <i>p</i> < 0.001). Plasma EBV DNA positivity at the time of complete remission and during post-treatment follow-up was significantly linked to lower PFS and OS rates in NK/TCL patients. Multivariate analysis revealed that advanced-stage disease, elevated β2-microglobulin, and EBV DNA level ≥ 3255 copies/mL at diagnosis were independent predictors for OS and PFS in NK/TCL patients.</p><p><strong>Conclusions: </strong>Plasma EBV DNA at diagnosis and during follow-up predict survival for NK/TCL patients but not for patients with other PTCL subtypes. Detection and monitoring of plasma EBV DNA levels at diagnosis and post-treatment follow-up for NK/TCL patients is recommended.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2478315"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of systemic sclerosis in the Asia-Pacific region: a systematic review and meta-analysis.","authors":"Ajanee Mahakkanukrauh, Chetta Ngamjarus, Porjai Pattanittum, Siraphop Suwannaroj, Patnarin Pongkulkiat, Tippawan Onchan, Chingching Foocharoen","doi":"10.1080/07853890.2025.2479238","DOIUrl":"10.1080/07853890.2025.2479238","url":null,"abstract":"<p><strong>Background: </strong>The epidemiological profile of systemic sclerosis (SSc) in the population in Asia-Pacific countries might help in planning for improved future care and research direction.</p><p><strong>Objectives: </strong>We aimed to estimate the pooled incidence and pooled prevalence of systemic sclerosis (SSc) in Asia-Pacific countries.</p><p><strong>Methods: </strong>We conducted and reported the systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement of 2020. Databases searched include PubMed, SCOPUS, CINAHL, and ProQuest, and hand searching, with a focus on publications from 1 January 2000 to 31 July 2023.</p><p><strong>Results: </strong>A total of 456 records were identified from the searches, 10 articles were included for review: six reported the incidence of SSc; nine reported the prevalence of SSc. We noted considerable heterogeneity. Subgroup analyses categorized by the period of study before and after the launch of the 2013 ACR/EULAR Classification Criteria for SSc demonstrated that both incidence and prevalence of SSc were significantly different between subgroups. The incidence of SSc before and after the launch was 1.85 per 100,000 (4 studies, I² = 100%, 95%CI 0.53-6.40) and 9.61 per 100,000 (2 studies, I² = 100%, 95%CI 4.90-18.85), respectively. The prevalence of SSc before and after the launch was 6.47 per 100,000 (6 studies, I² = 97%, 95%CI 5.09-8.21) and 18.48 per 100,000 (3 studies, I² = 100%, 95%CI 7.19-47.50), respectively.</p><p><strong>Conclusion: </strong>The epidemiology of SSc varied widely across the Asia-Pacific region depending on the study methodology and study period. The incidence of SSc in the Asia-Pacific region was estimated to be higher after the launch of the new classification criteria.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2479238"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of thrombocytopenia and D-dimer elevation with in-hospital mortality in acute aortic dissection.","authors":"Xingwei He, Abudunaibi Balati, Wenhua Wang, Hongjie Wang, Baoquan Zhang, Chunwen Li, Dan Yu, Suping Guo, Hesong Zeng","doi":"10.1080/07853890.2025.2478477","DOIUrl":"10.1080/07853890.2025.2478477","url":null,"abstract":"<p><strong>Background: </strong>Data on the association between the degree of platelet and coagulative-fibrinolytic variables abnormalities and the risk of in-hospital mortality in acute aortic dissection (AAD) are limited.</p><p><strong>Materials and methods: </strong>This multicentre retrospective cohort study included patients diagnosed with AAD by aortic computed tomographic angiography between 2010 and 2021 in five tertiary hospitals in China. The primary outcome was defined as all-cause mortality during hospitalization. Associations between platelet counts, coagulation-fibrinolytic parameters and all-cause in-hospital mortality were assessed using Cox proportional hazards regression models.</p><p><strong>Results: </strong>Among the 2567 participants, the median age was 54 years (interquartile range, IQR: 47-63); 531 (20.7%) were female, and the in-hospital mortality rate was 589 (23.0%). The Cox proportional hazards regression model indicated that lower platelet count, prothrombin activity (PTA), and fibrinogen levels and longer prothrombin time (PT) and thrombin time (TT) were linearly positively associated with an increased risk of in-hospital mortality (<i>p</i> < 0.05). A non-linear and positive association was confirmed between D-dimer levels and in-hospital mortality risk (<i>p</i> < 0.05). Additionally, a significant interaction between platelet counts and D-dimer levels was observed (<i>p</i> = 0.029). According to the subgroup analysis, compared to those in the reference group, those with thrombocytopenia (<140 × 10⁹/L) and high D-dimer levels (>14.6 µg/mL) had a 3.59-fold increased risk of in-hospital mortality (HR, 3.59; 95% CI, 2.00-6.42).</p><p><strong>Conclusions: </strong>Our analysis revealed associations between changes in platelet count, PT, PTA, TT, fibrinogen and D-dimer levels and outcomes in patients with AAD. Furthermore, the combined effect of thrombocytopenia and high D-dimer levels significantly increased the risk of in-hospital mortality.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2478477"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of iron in brain development, aging, and neurodegenerative diseases.","authors":"Qiqi Gao, Yiyang Zhou, Yu Chen, Wei Hu, Wenwen Jin, Chunting Zhou, Hao Yuan, Jianshun Li, Zhenlang Lin, Wei Lin","doi":"10.1080/07853890.2025.2472871","DOIUrl":"10.1080/07853890.2025.2472871","url":null,"abstract":"<p><p>It is now understood that iron crosses the blood-brain barrier <i>via</i> a complex metabolic regulatory network and participates in diverse critical biological processes within the central nervous system, including oxygen transport, energy metabolism, and the synthesis and catabolism of myelin and neurotransmitters. During brain development, iron is distributed throughout the brain, playing a pivotal role in key processes such as neuronal development, myelination, and neurotransmitter synthesis. In physiological aging, iron can selectively accumulate in specific brain regions, impacting cognitive function and leading to intracellular redox imbalance, mitochondrial dysfunction, and lipid peroxidation, thereby accelerating aging and associated pathologies. Furthermore, brain iron accumulation may be a primary contributor to neurodegenerative diseases such as Alzheimer's and Parkinson's diseases. Comprehending the role of iron in brain development, aging, and neurodegenerative diseases, utilizing iron-sensitive Magnetic Resonance Imaging (MRI) technology for timely detection or prediction of abnormal neurological states, and implementing appropriate interventions may be instrumental in preserving normal central nervous system function.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2472871"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of whole exome sequencing in the evaluation of isolated fetal growth restriction in normal chromosomal microarray analysis.","authors":"Xiaomei Shi, Yanling Huang, Hongke Ding, Lina Zhao, Wei He, Jing Wu","doi":"10.1080/07853890.2025.2476038","DOIUrl":"10.1080/07853890.2025.2476038","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the application of whole exome sequencing (WES) in the prenatal diagnosis of isolated fetal growth restriction (FGR) with a normal result by chromosomal microarray analysis (CMA).</p><p><strong>Methods: </strong>This retrospective study included singleton fetuses with isolated FGR in Guangdong Women and Children Hospital between July 2018 and August 2023. All fetuses were subjected to invasive prenatal testing with CMA and WES. Only cases with negative CMA results were included.</p><p><strong>Results: </strong>r  A total of 135 fetuses were included. Ultrasonography identified short long bones in 39 fetuses and nonshort long bones in 96 cases. WES revealed pathogenic/likely pathogenic (P/LP) variants in 16(11.9%) fetuses and variants of uncertain significance (VUS) in 2 (1.5%) fetuses. Compared to the nonshort long bones group, the short long bones group had a significantly higher detection rate of P/LP variants (33.3% [13/39] vs. 3.1% [3/96], p < 0.001, OR=15.5(4.1-58.5)). No significant differences were observed in the detection rates between severe FGR and nonsevere FGR (12.3% [13/106] vs. 10.3% [3/29], p= .000, OR=1.2(0.3-4.6)), or between the early-onset (12.9% [15/116]) and the late-onset group (5.3%[1/19],p =0.565, OR=2.7(0.3-21.5)).</p><p><strong>Conclusions: </strong>P/LP variants are more prevalent in fetuses with short long bones. WES is recommended for isolated FGR with short long bones, but further studies are needed to assess its utility in cases with nonshort long bones.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2476038"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistence of scrub typhus IgM and IgG antibodies among patients from Karnataka, India.","authors":"Kiran Chunduru, Manoj A R, Subhadra Poornima, Nagalakshmi Narasimhaswamy, Indira Bairy, Mridula M, Manjunatha Hande H, Shamee Shastry, Ramakrishna Devaki, George M Varghese, Kavitha Saravu","doi":"10.1080/07853890.2025.2468258","DOIUrl":"10.1080/07853890.2025.2468258","url":null,"abstract":"<p><strong>Background: </strong>The longevity of scrub typhus IgM and IgG are not clear. A region-specific diagnostic cut-off for enzyme-linked immunosorbent assay (ELISA) is a necessity for improved diagnosis.</p><p><strong>Objectives: </strong>To determine a region-specific optical density (OD) value cut-off for scrub typhus IgM and IgG ELISA and to study the persistence of these antibodies.</p><p><strong>Methods: </strong>A prospective cohort study was conducted among patients diagnosed with scrub typhus admitted to Kasturba Hospital, Manipal, Karnataka, India from August 2019 to April 2023. An equal number of scrub typhus patients and healthy volunteers were enrolled to determine region-specific scrub typhus IgM and IgG ELISA OD value cut-off. A receiver operating characteristic (ROC) curve analysis was performed to determine the OD value cut-off with an optimal combination of sensitivity and specificity. The patients were followed up prospectively at varying time points up to 18 months and scrub typhus IgM and IgG ELISA were performed in all the collected samples.</p><p><strong>Results: </strong>The ROC curve analysis of scrub typhus IgM revealed an optimal OD value cut-off of 1.309 with a sensitivity and specificity of 98.7% (95% CI: 93.1%-100%). The ROC curve analysis of scrub typhus IgG revealed an optimal OD value cut-off of 0.9 with a sensitivity of 71.7% (95% CI: 60.5%-81.4%) and specificity of 93.5% (95% CI: 85.7%-97.9%). At 18 months of follow-up, scrub typhus IgM (OD value > 1.309) and IgG (OD value > 0.9) were above the newly derived diagnostic cut-off in 17 (32%) and 40 (75.4%) patients, respectively.</p><p><strong>Conclusion: </strong>Scrub typhus IgM and IgG antibodies were persistent above the newly derived regional diagnostic cut-off for up to 18 months.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2468258"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium butyrate alleviates DSS-induced inflammatory bowel disease by inhibiting ferroptosis and modulating ERK/STAT3 signaling and intestinal flora.","authors":"Yingyin Liu, Nachuan Chen, Huaxing He, Lulin Liu, Suxia Sun","doi":"10.1080/07853890.2025.2470958","DOIUrl":"10.1080/07853890.2025.2470958","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), can seriously impact patients' quality of life. Sodium butyrate (NaB), a product of dietary fiber fermentation, has been shown to alleviate IBD symptoms. Some studies have shown that it is related to ferroptosis. However, the precise mechanism linking NaB, IBD, and ferroptosis is not clear.</p><p><strong>Objective: </strong>This study aimed to demonstrate that NaB suppresses ferroptosis, thereby alleviating inflammatory bowel disease (IBD) through modulation of the extracellular regulated protein kinases/signal transducer and activator of transcription 3 (ERK/STAT3) signaling pathway and intestinal flora.</p><p><strong>Methods: </strong>An IBD model was established using 2.5% (<i>w/v</i>) dextran sulfate sodium (DSS). Mice were orally administered low-dose NaB, high-dose NaB , or 5-aminosalicylic acid (5-ASA). Ferroptosis-related molecules were measured using specific kits, and western blotting (WB) and real-time polymerase chain reaction (RT-qPCR) were used to determine the levels of the target molecules.</p><p><strong>Results: </strong>NaB alleviated symptoms in IBD mice, including reduced weight loss, prolonged colon length, reduced disease activity index (DAI), and reduced spleen index and mRNA expression of inflammatory factors. Additionally, NaB reduced the content of Fe²⁺ and myeloperoxidase (MPO) and increased the content of GSH and the activity of superoxide dismutase (SOD), which reflected NaB-inhibited ferroptosis. Moreover, western blotting showed that NaB enhanced STAT3 and ERK phosphorylation. In addition, NaB regulates the composition and functions of flora related to IBD.</p><p><strong>Conclusion: </strong>NaB alleviates IBD by inhibiting ferroptosis and modulating ERK/STAT3 signaling and the intestinal flora.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2470958"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of atrial fibrillation screening: a meta-analysis of randomized controlled trials.","authors":"Ville Langén, Aleksi K Winstén, K E Juhani Airaksinen, Konsta Teppo","doi":"10.1080/07853890.2025.2457522","DOIUrl":"https://doi.org/10.1080/07853890.2025.2457522","url":null,"abstract":"<p><strong>Background: </strong>Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain.</p><p><strong>Materials and methods: </strong>We conducted a systematic review and meta-analysis of RCTs reporting clinical outcomes of systematic AF screening in participants without known AF. Pooled risk ratios (RRs) were computed for all-cause stroke or systemic embolism, major bleeding, and all-cause mortality, comparing screening with no screening.</p><p><strong>Results: </strong>Seven RCTs encompassing 76 458 participants were identified. One trial utilized implantable loop recorders for rhythm monitoring, while the others employed non-invasive screening methods. Pooled results indicated that AF screening was associated with a significant reduction in all-cause stroke or systemic embolism (RR 0.932, 95% CI 0.873-0.996, I² = 0%, <i>p</i> = 0.037), but had no effect on major bleeding (RR 0.996, 95% CI 0.935-1.060, I² = 0%, <i>p</i> = 0.876) or all-cause mortality (RR 0.987, 95% CI 0.945-1.031, I² = 0%, <i>p</i> = 0.550). We estimated a number needed to screen of 148 to prevent one stroke or systemic embolism over a 10-year period in a population of 75-year-olds. When only non-invasive screening methods were considered, the reduction in strokes was not statistically significant (RR 0.942, 95% CI 0.880-1.008, I² = 0%, <i>p</i> = 0.083).</p><p><strong>Conclusions: </strong>Systematic AF screening is associated with a modest yet statistically significant 7% relative reduction in stroke and systemic embolism, with no observed impact on major bleeding or all-cause mortality.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2457522"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-dose glucocorticoid treatment vs. glucocorticoid replacement in immune checkpoint inhibitor associated hypophysitis (CORTICI): an open, randomised controlled trial.","authors":"Verena Theiler-Schwetz, Christian Trummer, Lisa Schmitt, Angelika Terbuch, Barbara Obermayer-Pietsch, Erika Richtig, Stefan Pilz","doi":"10.1080/07853890.2025.2453829","DOIUrl":"10.1080/07853890.2025.2453829","url":null,"abstract":"<p><strong>Objective: </strong>One of the most severe endocrine side effects of immune checkpoint inhibitors (ICI) is hypophysitis leading to adrenal insufficiency. Recovery is rare, although it has been reported after high-dose glucocorticoid treatment. This is the first randomised study to evaluate whether hormonal recovery differs in patients treated with high-dose glucocorticoids versus glucocorticoid replacement therapy.</p><p><strong>Design/methods: </strong>In this single-centre, open, randomised controlled study, patients with ICI associated hypophysitis were randomised 1:1 to high-dose glucocorticoid treatment (1 mg/kg of prednisolone for two weeks, followed by tapering until week 7 and a switch to hydrocortisone 20 mg total daily dose in week 8) or glucocorticoid replacement therapy (hydrocortisone 20 mg total daily dose) over 8 weeks. The primary outcome was the frequency of hormonal axes recovery.</p><p><strong>Results: </strong>Between 17th April 2019 and 16th September 2022, 18 out of the 20 randomised patients finished the trial; eight completed high-dose, 10 glucocorticoid replacement. Nine patients presented with hyponatraemia, two had typical changes on MRI, 12 had isolated adrenal insufficiency, and six had an additional hormone deficiency. None of the patients in neither group experienced a recovery in adrenal function. One patient in each group showed amelioration of hypogonadism. There was a significant, unfavourable treatment effect of high-dose treatment on HbA1c (mean treatment effect 5.16, 95% confidence interval 0.31 to 10.02, <i>p</i> = 0.039).</p><p><strong>Conclusions: </strong>High-dose glucocorticoid treatment was not effective in restoring adrenal function and leads to adverse effects on glucose metabolism. We therefore do not recommend its use for the treatment of ICI associated hypophysitis, except for compressive symptoms.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2453829"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}