Journal of Internal Medicine最新文献

{"title":"Multicenter validation of secondary hemophagocytic lymphohistiocytosis diagnostic criteria","authors":"Gunnar Lachmann,&nbsp;Patrick Heeren,&nbsp;Friederike S. Schuster,&nbsp;Peter Nyvlt,&nbsp;Claudia Spies,&nbsp;Insa Feinkohl,&nbsp;Thomas Schenk,&nbsp;Wafa Ammouri,&nbsp;France Debaugnies,&nbsp;Lionel Galicier,&nbsp;Yuan Jia,&nbsp;Nikhil Meena,&nbsp;Carole Nagant,&nbsp;Olaf Neth,&nbsp;Stefan Nierkens,&nbsp;Juan San Martin,&nbsp;Hao Wei (Linda) Sun,&nbsp;Yini Wang,&nbsp;Zhao Wang,&nbsp;Jae-Ho Yoon,&nbsp;Frank M. Brunkhorst,&nbsp;Paul La Rosée,&nbsp;Gritta Janka,&nbsp;Cornelia Lachmann","doi":"10.1111/joim.20065","DOIUrl":"10.1111/joim.20065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>Five fulfilled hemophagocytic lymphohistiocytosis (HLH)-2004 criteria, and the HScore are widely used and recommended by international expert consensus to diagnose secondary HLH. Both diagnostic scores have never been validated in heterogeneous patient cohorts of secondary HLH patients. We aimed to systematically optimize and validate diagnostic criteria of secondary HLH using a multicenter approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods:</h3>\u0000 \u0000 <p>We developed optimized criteria in our cohort of critically ill patients as a first step. We next validated these new criteria together with the original and modified HLH-2004 criteria as well as the HScore using original data of 13 published cohorts, which were identified by a systematic literature search.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>The best performing HLH diagnostic criteria sets over all 13 validation cohorts were the original HLH-2004 criteria with a decreased cut-off (cut-off 4, mean sensitivity 86.5%, mean specificity 86.1%), followed by the revised HLH-2004 criteria (natural killer cell activity removed; cut-off 4, mean sensitivity 83.8%, mean specificity 87.8%) and the HScore (cut-off 169, mean sensitivity 82.4%, mean specificity 87.6%). Our newly developed HLH diagnostic criteria showed inferior performance. Ferritin ≥500 µg/L had 94.0% mean sensitivity over all cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions:</h3>\u0000 \u0000 <p>In this first multicenter validation study, four fulfilled HLH-2004 criteria and an HScore of 169 were suitable to diagnose secondary HLH, which will lead to rapid diagnosis and improved patient outcomes. Ferritin proved as a reliable HLH screening marker. Our results should be taken into account in clinical recommendations and in designing new studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"312-327"},"PeriodicalIF":9.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044987","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":"Cardiovascular, cancer, and infection risks of Janus kinase inhibitors in rheumatoid arthritis and ulcerative colitis: A nationwide cohort study","authors":"Yongtai Cho,&nbsp;Dongwon Yoon,&nbsp;Farzin Khosrow-Khavar,&nbsp;Minkyo Song,&nbsp;Eun Ha Kang,&nbsp;Ju Hwan Kim,&nbsp;Ju-Young Shin","doi":"10.1111/joim.20064","DOIUrl":"10.1111/joim.20064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evolving evidence suggests that patients undergoing treatment with Janus kinase inhibitors (JAKi) may face an increased risk of cardiovascular events, malignancies, and serious infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We assessed cardiovascular, malignancy, and serious infection risks associated with JAKi use compared to tumor necrosis factor inhibitor (TNFi) use, which served as the active comparator, in patients with rheumatoid arthritis (RA) or ulcerative colitis (UC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study emulated a target trial using South Korea's nationwide claims database (2013–2023). We constructed two separate cohorts comprising new users of JAKi or TNFi with either RA or UC and performed overlap weighting to control for confounders. Outcomes included three-point-major adverse cardiovascular events (3P-MACE) (cardiovascular death, myocardial infarction, and stroke), malignancy, and serious infection. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The RA cohort included 14,972 patients, with 4759 initiating JAKi. The UC cohort included 2085 patients, with 347 initiating JAKi. In the overall RA cohort, the weighted HR was 0.92 (95% CI 0.59–1.42) for 3P-MACE, 1.61 (1.08–2.41) for malignancy, and 1.08 (0.94–1.23) for serious infection. In the overall UC cohort, the weighted HR was 0.98 (0.11–8.42) and 0.45 (0.26–0.78) for malignancy and serious infection, respectively. No 3P-MACE cases were observed in JAKi users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>JAKis were associated with an elevated risk of malignancy but no significant difference in the risk of 3P-MACE and serious infection among all patients with RA. Further data are needed regarding the risk of malignancy and 3P-MACE in patients with UC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 4","pages":"366-381"},"PeriodicalIF":9.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044948","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":"Authors reply: Obesity treatment in adolescents and adults in the era of personalized medicine","authors":"Magnus Sundbom,&nbsp;Kajsa Järvholm,&nbsp;Lovisa Sjögren,&nbsp;Paulina Nowicka,&nbsp;Ylva Trolle Lagerros","doi":"10.1111/joim.20062","DOIUrl":"10.1111/joim.20062","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;Our thanks go to Mazzetto et al. [&lt;span&gt;1&lt;/span&gt;] for their interest in our paper on personalized obesity treatment, recently published in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We welcome their comments on the interesting connection between obesity treatment and chronic cutaneous conditions, especially because these aspects are not commonly noted in clinical practice. At present, treatment with the new glucagon-like peptide-1 (GLP-1) receptor agonists is demonstrated to have beneficial effects on various conditions besides obesity and diabetes type 2, such as reducing the risk of worsened cardiovascular outcomes [&lt;span&gt;3&lt;/span&gt;] and delaying the progression of diabetes-related nephropathy [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Obesity is characterized by a state of chronic inflammation. Thus, weight loss as such could be hypothesized to lead to inflammation improvement. Nonetheless, consistent evidence from both preclinical studies and clinical trials suggests that GLP-1 receptor agonists exhibit anti-inflammatory effects influencing the immune system, irrespective of glycemic state and even before significant weight loss occurs. These potential immunomodulatory effects of GLP-1 and its agonists introduce new possibilities for treating inflammatory diseases.&lt;/p&gt;&lt;p&gt;GLP-1 receptor agonists have been shown to be associated with a decrease of inflamed airways causing asthma attacks [&lt;span&gt;5&lt;/span&gt;], to improve the inflammation in metabolic dysfunction-associated steatotic liver disease [&lt;span&gt;6&lt;/span&gt;], and as Mazzetto et al. point out [&lt;span&gt;1&lt;/span&gt;], a number of studies have also shown improvements in psoriasis, another inflammatory condition. This anti-inflammatory effect on chronic cutaneous conditions, such as psoriasis, has also been found after metabolic and bariatric surgery. GLP-1 levels substantially increase postoperatively, suggesting that the response is GLP-1 mediated.&lt;/p&gt;&lt;p&gt;In the Swedish Obese Subjects study comparing persons who had metabolic and bariatric surgery to controls with obesity, none had psoriasis at baseline. However, during 25 years of follow-up, metabolic and bariatric surgery were associated with a lower incidence of psoriasis, HR: 0.65 [0.47–0.89] [&lt;span&gt;7&lt;/span&gt;]. Interestingly, a longer duration of obesity was independently associated with a higher risk for psoriasis, thus supporting that chronic inflammation is a risk factor. However, the degree of weight loss seems important, as gastric bypass surgery reduced both the risk of new-onset psoriasis (adjusted HR 0.52 [0.33–0.81]) and progression to severe psoriasis (adjusted HR 0.44 [0.23–0.86]) in a population-based Danish study, whereas gastric banding—resulting in lower weight loss—demonstrated a slightly increased risk for both conditions with time [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this context, we would also like to remind all readers of the frequent need for excess skin removal after successful obesity treatment with significant weight","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"341-342"},"PeriodicalIF":9.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035480","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":"Acknowledgement to reviewers","authors":"","doi":"10.1111/joim.20061","DOIUrl":"10.1111/joim.20061","url":null,"abstract":"&lt;p&gt;The &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; acknowledges the valuable contribution of the close to 450 reviewers who have helped in the scientific evaluation of manuscripts submitted to the journal in 2024. In addition to our authors and editorial board, these individuals from all over the world have helped the journal in its goal of becoming a high-ranking international publication.&lt;/p&gt;&lt;p&gt;Abolhassani, Hassan, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Abrahamsen, Bo, &lt;i&gt;Denmark&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Alicic, Radica, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Alina, Allen, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Ambrosio, Giuseppe, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Andersson, Daniel, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Argiles, Angel, &lt;i&gt;France&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Arias, Elizabeth, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Arkema, Elizabeth, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Askling, Johan, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Asola, Markku, &lt;i&gt;Finland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Aubin, Henri-Jean, &lt;i&gt;France&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Aveyard, Paul, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Babio, Nancy, &lt;i&gt;Spain&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Baden, Megu, &lt;i&gt;Japan&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Banach, Maciej, &lt;i&gt;Poland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bellasi, Antonio, &lt;i&gt;Switzerland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bellelli, Giuseppe, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Ben-Zvi, Ilan, &lt;i&gt;Israel&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Berg Wulff, Anders, &lt;i&gt;Denmark&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bergen, Sarah&lt;i&gt;, Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Berlin, Ivan, &lt;i&gt;Switzerland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Berti, Alvise, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bertsias, George, &lt;i&gt;Greece&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Besson, Caroline, &lt;i&gt;France&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bilson, Josh, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björk, Jonas, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björkelund, Cecilia, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björkström, Karl, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björnsson, Einar, &lt;i&gt;Iceland&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Björnstedt, Mikael, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Blaha, Michael, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bonora, Enzo, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Boriani, Giuseppe, &lt;i&gt;Italy&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Boris, Jeffrey, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bottai, Matteo, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Braunschweig, Frieder, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brennan, Paul, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brenner, Hermann, &lt;i&gt;Germany&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brismar, Torkel, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Broberg, Craig, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brown, Gregory, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brown, Jenifer Michelle, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bruchfeld, Annette, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Brunström, Mattias, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Bures, Jan, &lt;i&gt;Czech Republic&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Burnett, John, &lt;i&gt;Australia&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Byrne, Christopher, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Calderón-Larrañaga, Amaia, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Calvet Calvo, Xavier, &lt;i&gt;Spain&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Cameron, Natalie, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Camilleri, Michael, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Canfield, Claire Ann, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Cañas, Carlos, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Canevelli, Marco, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carballo Casla, Adrian, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carlberg, Bo, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carlsson, Axel, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carlsson, Sofia, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Carsons, Steven, &lt;i&gt;United States&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Chantzichristos, Dimitrios, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Chatzidionysiou, Katerina, &lt;i&gt;Sweden&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Chen, Yuntao, &lt;i&gt;United Kingdom&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Cho, Young-Rak, &lt;i&gt;Korea&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Christensen, Jacob, &lt;i&gt;Norway&lt;/i&gt;&lt;/p&gt;&lt;p&gt;Clement, ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"343-347"},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996952","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":"Diagnosis and treatment of chronic kidney diseases and Type 2 diabetes mellitus: a paradigm shift for enhancing cardiovascular prognosis.","authors":"Joachim Jankowski","doi":"10.1111/joim.20060","DOIUrl":"https://doi.org/10.1111/joim.20060","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996956","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":"Kidney function decline improves after lithium discontinuation","authors":"Filip Fransson,&nbsp;Ursula Werneke,&nbsp;Louise Öhlund,&nbsp;P. Andreas Jonsson,&nbsp;Michael Ott","doi":"10.1111/joim.20054","DOIUrl":"10.1111/joim.20054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Long-term lithium treatment decreases kidney function. However, it remains unclear whether stopping lithium improves kidney function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To study kidney function in patients who stopped and subsequently restarted lithium treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mirror-image design using data from the LiSIE retrospective cohort study. The mirror was set to when lithium was stopped with a 5-year pre- and post-mirror period. Adult patients with bipolar, schizoaffective disorder or unipolar depression, who had lithium ≥4.5 years in the pre-mirror period, were included. Creatinine measurements were available from 1997 to 2017. The main outcome was the difference in mean annual change of the estimated glomerular filtration rate (eGFR) adjusted for sex, hypertension and diabetes mellitus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 168 participants (94 women, 74 men) were included. Mean annual eGFR change was −1.58 (−1.87 to −1.28) mL/min/1.73 m²/year before and −0.023 (−0.49 to +0.44) mL/min/1.73 m²/year after lithium discontinuation (<i>p</i> &lt; 0.0001 for difference). The improvement was 0.77 (0.35–1.20) mL/min/173 m²/year in participants with eGFR &gt;60 mL/min/1.73 m², and 3.03 (2.15–3.92) mL/min/1.73 m²/year for participants with eGFR &lt;30 mL/min/1.73 m². The effect was persistent over the 5-year post-mirror study period. For participants restarting lithium, the mean annual eGFR change was −1.71 (−2.26 to −1.16) mL/min/1.73 m²/year, a setback compared to their lithium-free post-mirror period (<i>p</i> &lt; 0.0001). We did not see any difference compared to the pre-mirror period (<i>p</i> = 0.51).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Stopping lithium slowed down mean eGFR decline. This effect was more pronounced in participants with lower eGFR at the time of lithium discontinuation. In participants who restarted lithium, the annual decline of eGFR reverted to pre-lithium discontinuation levels.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"289-299"},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997079","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":"Challenges and opportunities in organ donation after circulatory death","authors":"Mathias Vidgren,&nbsp;Capucine Delorme,&nbsp;Gabriel C. Oniscu","doi":"10.1111/joim.20051","DOIUrl":"10.1111/joim.20051","url":null,"abstract":"<p>In recent years, there has been resurgence in donation after circulatory death (DCD). Despite that, the number of organs transplanted from these donors remains low due to concerns about their function and a lack of an objective assessment at the time of donation. This overview examines the current DCD practices and the classification modifications to accommodate regional perspectives. Several risk factors underscore the reluctance to accept DCD organs, and we discuss the modern strategies to mitigate them. The advent of machine perfusion technology has revolutionized the field of DCD transplantation, leading to improved outcomes and better organ usage. With many strategies at our disposal, there is an urgent need for comparative trials to determine the optimal use of perfusion technologies for each donated organ type. Additional progress in defining therapeutic strategies to repair the damage sustained during the dying process should further improve DCD organ utilization and outcomes. However, there remains wide variability in access to DCD donation and transplantation, and organizational efforts should be doubled up with consensus on key ethical issues that still surround DCD donation in the era of machine perfusion.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"124-140"},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142996953","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":"Regarding: Delirium and frailty in older adults: Clinical overlap and biological underpinnings","authors":"José Lucas Sena da Silva,&nbsp;Juliana Caldas","doi":"10.1111/joim.20048","DOIUrl":"10.1111/joim.20048","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;The review by Bellelli et al. recently published in the &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; examines the relationship between frailty and delirium—two geriatric syndromes that significantly impact morbidity, mortality, functionality, cognition, quality of life, healthcare costs, and caregiver burden [&lt;span&gt;1&lt;/span&gt;]. The authors assess the current evidence regarding how these conditions share risk factors, prevalence, consequences, and pathophysiology and whether they potentially constitute a syndrome in their own right. Although their findings are of significant importance and raise other compelling discussions, we would like to offer some additional comments for consideration.&lt;/p&gt;&lt;p&gt;First, their findings highlight our limitations in understanding the pathophysiology of these conditions. It is noteworthy that various medications targeting different mechanisms thought to be involved in the occurrence of delirium are being investigated for prevention and treatment. However, the results remain inconsistent and do not significantly influence severity, duration, or recurrence [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;It is also pertinent to question how frequently we underdiagnose cognitive decline upon hospital admission. We know that this decline often goes unnoticed by family members and caregivers, making it less likely to be spontaneously reported in clinical settings. Such an assessment is crucial for investigating a possible connection between frailty and delirium, given that cognitive decline is a common risk factor for both conditions, though it may be less evident for the untrained eye in the earlier stages.&lt;/p&gt;&lt;p&gt;Moreover, we face a clinical reality—previously highlighted by large studies—regarding the inconsistency of clinical practices in delirium prevention. We must ask whether—were these protocols to be effectively implemented—we could prevent delirium even in frail patients. This would contribute to either reinforcing or undermining the hypothesis of a singular syndrome. Nevertheless, we still lack high-quality clinical evidence regarding the best strategies for preventing delirium, let alone their consistent implementation in clinical practice [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;It seems imperative to engage in a multidisciplinary approach to the prevention of these conditions. While this may entail short-term increases in healthcare expenditures for ongoing education of clinical teams, hiring additional staff, and logistical reorganization, studies on delirium suggest that its prevention may result in reduced rates of hospital length of stay and readmission [&lt;span&gt;4&lt;/span&gt;]. Moreover, frail patients who develop delirium are more susceptible to a feedback loop of these conditions, which can lead to adverse clinical outcomes, including increased rates of infection, hospitalization, and intensive care unit admissions, as well as the utilization of sedatives.&lt;/p&gt;&lt;p&gt;It is important to note that although the review by Bellelli et al. contributes ","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 2","pages":"230-231"},"PeriodicalIF":9.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982018","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":"Clinical 7 Tesla magnetic resonance imaging: Impact and patient value in neurological disorders","authors":"Elisabeth de Vries,&nbsp;Caroline Hagbohm,&nbsp;Russell Ouellette,&nbsp;Tobias Granberg","doi":"10.1111/joim.20059","DOIUrl":"10.1111/joim.20059","url":null,"abstract":"<p>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.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"244-261"},"PeriodicalIF":9.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941921","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":"Metabolic syndrome is associated with breast cancer mortality: A systematic review and meta-analysis","authors":"Sixten Harborg,&nbsp;Helene Borup Larsen,&nbsp;Stine Elsgaard,&nbsp;Signe Borgquist","doi":"10.1111/joim.20052","DOIUrl":"10.1111/joim.20052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This systematic review and meta-analysis assesses the association between metabolic syndrome and breast cancer (BC) outcomes in BC survivors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"297 3","pages":"262-275"},"PeriodicalIF":9.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941974","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}