Journal of Internal Medicine最新文献

Magnetic resonance imaging (MRI) is a cornerstone of non-invasive diagnostics and treatment monitoring, particularly for diseases of the central nervous system. Although 1.5- and 3 Tesla (T) field strengths remain the clinical standard, the advent of 7 T MRI represents a transformative step forward, offering superior spatial resolution, contrast, and sensitivity for visualizing neuroanatomy, metabolism, and function. Recent innovations, including parallel transmission and deep learning-based reconstruction, have resolved many prior technical challenges of 7 T MRI, enabling its routine clinical use. This review examines the diagnostic impact, patient value, and practical considerations of 7 T MRI, emphasizing its role in facilitating earlier diagnoses and improving care in conditions, such as amyotrophic lateral sclerosis (ALS), epilepsy, multiple sclerosis (MS), dementia, parkinsonism, tumors, and vascular diseases. Based on insights from over 1200 clinical scans with a second-generation 7 T system, the review highlights disease-specific biomarkers such as the motor band sign in ALS and the new diagnostic markers in MS, the central vein sign, and paramagnetic rim lesions. The unparalleled ability of 7 T MRI to study neurological diseases ex vivo at ultra-high resolution is also explored, offering new opportunities to understand pathophysiology and identify novel treatment targets. Additionally, the review provides a clinical perspective on patient handling and safety considerations, addressing challenges and practicalities associated with clinical 7 T MRI. By bridging research and clinical practice, 7 T MRI has the potential to redefine neuroimaging and advance the understanding and management of complex neurological disorders.

Background: This systematic review and meta-analysis assesses the association between metabolic syndrome and breast cancer (BC) outcomes in BC survivors.

Methods: Systematic searches were carried out in PubMed and Embase using variations of the search terms: breast neoplasms (population), metabolic syndrome (exposure), and survival (outcome). Metabolic syndrome was characterized according to the American Heart Association, which includes the presence of three out of five abnormal findings among the risk factors: high blood pressure, high triglycerides, low high-density lipoprotein, high fasting glucose, and central obesity. Data were obtained from observational studies and randomized controlled trials that utilized survival statistics and reported survival ratios to investigate how the presence of metabolic syndrome at the time of BC diagnosis is associated with BC outcomes. Study data were independently extracted by two authors, and effect sizes were pooled using random-effects models.

Results: From the 1019 studies identified in the literature search, 17 were deemed eligible. These encompassed 42,135 BC survivors. The pooled estimates revealed that BC survivors who had metabolic syndrome at the time of their BC diagnosis experienced increased risk of recurrence (HR 1.69, 95% CI: 1.39-2.06), BC mortality (HR 1.83, 95% CI: 1.35-2.49), and shorter disease-free survival (HR 1.57, 95% CI: 1.36-1.81) compared to BC survivors without metabolic syndrome.

Conclusions: Among BC survivors, metabolic syndrome was associated with inferior BC outcomes. This necessitates the creation of clinical guidelines that include metabolic screening for BC survivors. Further research should identify effective interventions to reduce the prevalence of metabolic syndrome among BC survivors to improve metabolic health and BC outcomes.

Objective: To estimate the incidence, prevalence, and outcomes of patients with diagnosed alpha-1-antitrypsin deficiency (AATD) in Sweden, 2002-2020.

Study design and setting: The Swedish National Patient Registry was utilized to identify patients with a first diagnosis of AATD between 2002 and 2020. Each patient was matched with up to 10 comparators from the general population. AATD incidence and prevalence were estimated. Causes of death and rates of mortality, transplantation, lung disease, liver cirrhosis, and previous neonatal cholestasis were estimated.

Results: The incidence rate of AATD was 1.83 (95% confidence interval [CI] 1.58-2.11) per 100,000 person-years and the total prevalence was 21.04 (95%CI = 20.17-21.94) per 100,000 persons at the end of 2020. Mortality was 3.55 times higher (95%CI = 3.15-3.99) for patients with AATD. Rates of liver-(hazard ratio [HR] = 22.95, 95%CI = 12.61-41.75), lung-(HR = 12.09, 95%CI = 8.87-16.47), and cardiovascular (HR = 1.90, 95%CI = 1.45-2.90) related death were higher in patients with AATD. The cumulative incidence after 10 years of follow-up was 1.69% (95%CI = 1.15-2.41) for liver transplantation and 4.14% (95%CI = 3.20-5.26) for lung transplantation. About 20% of patients were estimated to be alive without lung disease or liver cirrhosis 20 years after an AATD diagnosis. Neonatal cholestasis codes were found in 3.0% of AATD patients and 0.5% of comparators (odds ratio 6.28, 95%CI = 3.81-10.36).

Conclusions: In this population-based cohort study on AATD in Sweden, an increasing incidence was observed, and significantly higher rates of death from liver, lung, and cardiovascular causes compared to the general population were found. Only a minority of diagnosed AATD patients were estimated to be free of liver cirrhosis and lung disease after 20 years.

Chronic kidney disease (CKD) is a prevalent and progressive condition associated with significant mortality and morbidity. Diabetes is a common cause of CKD, and both diabetes and CKD increase the risk of cardiovascular disease (CVD), the leading cause of death in individuals with CKD. This review will discuss the importance of early detection of CKD and prompt pharmacological intervention to slow CKD progression and delay the development of CVD for improving outcomes. Early CKD is often asymptomatic, and diagnosis usually requires laboratory testing. The combination of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) measurements is used to diagnose and determine CKD severity. Guidelines recommend at least annual screening for CKD in at-risk individuals. While eGFR testing rates are consistently high, rates of UACR testing remain low. This results in underdiagnosis and undertreatment of CKD, leaving many individuals at risk of CKD progression and CVD. UACR testing is an actionable component of the CKD definition. A four-pillar treatment approach for slowing the progression of diabetic kidney disease is suggested, comprising a renin-angiotensin-system (RAS) inhibitor, a sodium-glucose cotransporter 2 inhibitor, a glucagon-like peptide 1 receptor agonist, and the nonsteroidal mineralocorticoid receptor antagonist finerenone. The combination of these agents provides a greater cardiorenal risk reduction compared with RAS inhibitors alone. Early detection of CKD and prompt intervention with guideline-directed medical therapy are crucial for reducing CVD risk in individuals with CKD and diabetes. Evidence from ongoing studies will advance our understanding of optimal therapy in this population.

Background: Fluid overload remains critical in managing patients with end-stage kidney disease. However, there is limited empirical understanding of fluid overload's impact on mortality. This study analyzes fluid overload trajectories and their association with mortality in hemodialysis patients.

Methods and patients: This longitudinal study included 9332 incident hemodialysis patients from the EuCliD database, treated in Fresenius Medical Care NephroCare dialysis centers across seven countries between January 2016 and December 2019, with follow-up until May 2023. Fluid overload was assessed using bioimpedance spectroscopy, and patients were grouped based on fluid overload trajectories using group-based trajectory modeling. Cox regression models, adjusted for potential confounders, were used to investigate the relationship between trajectory groups and mortality.

Results: Four distinct fluid overload trajectories were identified. Patients in the highest trajectory group (8.5% of the cohort) had more frequent background cardiovascular complications, lower BMI and serum albumin, and their adjusted mortality risk was 2.20 times higher than the lowest trajectory. There was a dose-response relationship between trajectories and mortality. The incidence rate of death increased with the degree of fluid overload, from 8.6 deaths per 100 person-years in the lowest trajectory to 18.6 in the highest.

Conclusions: This longitudinal study highlights the significant risk of chronic fluid overload in hemodialysis patients. Latent trajectory analysis provides novel information into the dynamic nature of fluid overload and its impact on mortality in the hemodialysis population.

Background: Large-scale trials evaluating a multicomponent lifestyle intervention aimed at weight loss on kidney function are lacking.

Methods: This was a post hoc analysis of the "PREvención con DIeta MEDiterránea-Plus" (PREDIMED-Plus) randomized controlled trial, including patients with overweight/obesity and metabolic syndrome, measured cystatin C and creatinine. Participants were randomly assigned (1:1) to an intensive weight loss lifestyle intervention (intervention group [IG]) consisting of an energy-restricted Mediterranean diet (MedDiet), physical activity promotion and behavioral support, or a control group (CG) receiving ad libitum MedDiet recommendations. The primary outcome was between-group differences in cystatin C-based kidney function (cystatin C-based estimated glomerular filtration rate-eGFRcys-and combined cystatin C-creatinine-based eGFR-eGFRcr-cys) change from baseline to 12 and 36 months. Secondary outcomes included between-group differences in creatinine-based eGFR (eGFRcr) and urinary albumin-to-creatinine ratio (UACR) change and the predictive capacity of these formulas at baseline for new-onset chronic kidney disease (CKD).

Results: A total of 1909 participants (65 ± 5 years, 54% men) were included. Twelve-month decline in eGFRcys, eGFRcr-cys, and eGFRcr was greater in the CG compared to the IG, with between-group differences of -1.77 mL/min/1.73 m² [95% confidence interval -2.92 to -0.63], -1.37 [-2.22 to -0.53], and -0.91 [-1.74 to -0.71], respectively. At 36 months, the decline in eGFRcr-cys and eGFRcr was greater in the CG. No between-group differences in UACR were found. Significant adjusted areas under the curve for baseline eGFRcys and eGFRcr-cys were observed for incident CKD at 36 months, which were similar to those for eGFRcr and UACR.

Conclusions: In older adults with overweight/obesity and metabolic syndrome, the PREDIMED-Plus intervention may be an optimal approach to preserve kidney function.