Internal and Emergency Medicine最新文献

{"title":"The search for the best sustainable foods requires accurate and comprehensive functional assessment oriented to health.","authors":"Mohamad Khalil, Harshitha Shanmugam, Agostino Di Ciaula, Piero Portincasa","doi":"10.1007/s11739-025-04129-5","DOIUrl":"https://doi.org/10.1007/s11739-025-04129-5","url":null,"abstract":"<p><p>To meet the United Nations Sustainable Development Goals (SDGs), especially SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being) (SDGs https://sdgs.un.org/goals ), we need to overcome the concept of merely increasing food availability. A modern food system must include the delivery of healthy and sustainable functional foods, i.e., foods built with minimal environmental impact which delivers enhanced health benefits. These foods must support human physiology by positively influencing food intake regulation, food liking, satiety, digestion, as well as metabolic homeostasis, in the absence of negative environmental outcomes. Yet, their success hinges not only on their nutritional profiles, but also on sensory acceptability and a deep understanding of food-body interactions starting from the gastrointestinal (GI) tract and beyond. In this point of view, we add to existing reviews and consensus statements, integration of sensory perception, gastrointestinal physiology, and gut-brain signaling into the design of sustainable functional foods. While previous work has often considered these elements separately, we explicitly connect them within the context of the SDGs, emphasizing that sustainable foods must not only be nutritionally beneficial and environmentally responsible, but also physiologically effective and sensorially acceptable. This multidimensional approach highlights the need for interdisciplinary strategies that go beyond traditional definitions of functional foods and sustainability.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Invasive Characterization of Lower Extremity Deep Vein Thrombosis via Advanced Ultrasound Elastography: A Prospective Pilot Study.","authors":"Nicola Potere, Mattia Giulianelli, Matteo Candeloro, Maria Domenica Guglielmi, Silvana Pardi, Marcello Di Nisio, Ettore Porreca","doi":"10.1007/s11739-025-04135-7","DOIUrl":"https://doi.org/10.1007/s11739-025-04135-7","url":null,"abstract":"<p><p>Duplex ultrasonography is the preferred non-invasive imaging technique for diagnosing lower extremity deep vein thrombosis (DVT), but considered largely unreliable for determining thrombus-specific features. Elastosonography techniques including real-time strain elastography (RT-SE) are widely used in clinical practice to assess tissue elasticity, but its potential remains largely unrealized in DVT, where RT-SE might provide adjunct information on thrombus biomechanical properties potentially aiding clinical decision-making. This single-center prospective pilot study investigates the use of modern RT-SE imaging enhanced with an advanced quantification software for reconstructive tissue elasticity analysis in patients with symptomatic acute lower-extremity DVT objectively diagnosed within 6 months of enrollment. Between-group differences in median thrombus elasticity, assessed via a newly proposed elasticity biomarker, namely thrombus tissue deformation index, were evaluated using Mann-Whitney U or Kruskal-Wallis tests. Relationships between thrombus elasticity and patient-, DVT- and anticoagulation-related factors were assessed through Spearman's rank-order correlation. Thirty-eight deep venous thrombi were analyzed using advanced RT-SE, in addition to standard duplex ultrasonography (i.e., triplex ultrasonography). Median thrombus elasticity was 25.7% (interquartile range [IQR], 22.1-26.1), 20.8% (IQR, 17.1-22.1), and 3.8% (IQR, 1.3-6.6) in acute, sub-acute, and chronic DVT, respectively (p < 0.001). Thrombus elasticity robustly correlated with the period of DVT diagnosis (i.e., lower elasticity with increasing thrombus chronological age; ρ = -0.70, p < 0.0001). Elasticity of chronic thrombi inversely correlated with dynamic changes in residual vein obstruction (i.e., higher elasticity of thrombi undergoing smaller size reduction over time; ρ = 0.85, p < 0.0001). These findings preliminarily identify modern advanced RT-SE imaging as a viable and easily-implementable tool for enhanced non-invasive thrombus characterization, with the potential to inform thrombus-guided management strategies in patients with DVT.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: HFpEF and HFmrEF in acute heart failure: isolated diastolic dysfunction or alternative cardiac pathologies?","authors":"Maria Giulia Bellicini","doi":"10.1007/s11739-025-04132-w","DOIUrl":"https://doi.org/10.1007/s11739-025-04132-w","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piercing the evidence: intravenous versus intraosseous vascular access during out-of-hospital cardiac arrest.","authors":"Carmine De Luca, Roberto Emolo, Andrea Portoraro, Alessia Cecchini, Alice Paribello","doi":"10.1007/s11739-025-04134-8","DOIUrl":"https://doi.org/10.1007/s11739-025-04134-8","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality despite advances in resuscitation. Establishing vascular access is essential for the administration of life-saving drugs during cardiopulmonary resuscitation. Intravenous (IV) access has traditionally been recommended as the first-line approach, although this choice is supported by limited evidence. Intraosseous (IO)access, increasingly used for its rapidity and reliability, offers a potential alternative, but human data regarding pharmacokinetics and clinical outcomes are scarce. The IVIO trial was a multicenter randomized controlled study conducted in Denmark, designed to compare IO and IV access in adults with non-traumatic OHCA. A total of 1,479 patients were randomized 1:1 to receive IO (n=731) or IV (n=748) access. Successful access within two attempts was achieved in 92% of IO cases and 80% of IV cases. Sustained return of spontaneous circulation (ROSC), the primary outcome, occurred in 30% of patients in the IO group and 29% in the IV group (Risk Ratio [RR] 1.06; 95% CI, 0.90-1.24; p=0.49). At 30 days, survival was 12% in the IO group compared with 10% in the IV group (RR 1.16; 95% CI, 0.87-1.56), while favorable neurological outcome was observed in 9% versus 8% (RR 1.16; 95% CI, 0.83-1.62). None of these differences reached statistical significance. CT imaging confirmed correct placement in 71% of humeral and 100% of tibial IO accesses, with no severe complications reported. The trial found no significant differences between the two strategies, supporting IO access as an alternative when IV placement is difficult or delayed in OHCA management.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating rates of ER visits in those who completed Medicare annual wellness visits in a federally qualified health center setting.","authors":"Ashruta Patel","doi":"10.1007/s11739-025-04121-z","DOIUrl":"https://doi.org/10.1007/s11739-025-04121-z","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether completing a Medicare annual wellness visit has a lower association with emergency room visits in a federally-qualified health center setting.</p><p><strong>Methods: </strong>We examined rates of emergency room visits of Medicare beneficiaries in those who completed Medicare annual wellness visits to those who did not complete Medicare annual wellness visits from January 2024 toDecember 2024.</p><p><strong>Results: </strong>The rates of emergency room visits are lower in those who completed Medicare annual wellness visits.</p><p><strong>Conclusions: </strong>Federally qualified health center settings should prioritize scheduling and targeting patients for Medicare annual wellness visits, as completion of these visits have the potential to reduce emergency visits.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tilt testing or implantable cardiac monitoring in the diagnosis of unexplained syncope.","authors":"Alessandra Rabajoli, Derek Chew, Joshua Szaszkiewicz, Satish Raj, Marlon Cua, Carlos Morillo, Robert Sheldon","doi":"10.1007/s11739-025-04128-6","DOIUrl":"https://doi.org/10.1007/s11739-025-04128-6","url":null,"abstract":"<p><p>After initial evaluation, many older syncope patients do not receive a diagnosis. Both head-up tilt tests (HUTT) and implanted cardiac monitors (ICM) are recommended, but there is no consensus about which should be done first. The study objective was to assess whether first conducting a HUTT vs ICM provided a higher, earlier diagnostic yield. This single-center, retrospective analysis study included patients with undiagnosed syncope and age ≥ 5o years after clinical and ECG evaluation. Exclusion criteria included ECG conduction abnormalities and structural heart disease with left ventricular ejection fraction < 50%. The primary outcome was an etiologic diagnosis of syncope within 1 year; secondary outcomes included time to diagnosis and the proportion with a syncope diagnosis at the end of follow-up. There were 233 patients (135 males), mean age 69 ± 10 years, with a median 3 historical syncopes. Baseline characteristics were similar except the ICM group had more mild cardiomyopathies, injuries, and beta-blockers and diuretic therapies. After one year, there were more diagnostic outcomes in the HUTT (65/104, 63%) than in the ICM (37/129, 29%) group (p < 0.00001). There were more diagnostic outcomes in the HUTT group by study completion (69/104 vs 58/129, p = 0.0015). The median times to a syncope diagnosis were 1 day in the HUTT group and 97 days in the ICM group (hazard ratio 3.88, CI 2.66, 5.67; p < 0.001). In older patients with syncope of unknown etiology, first conducting a HUTT provided an earlier and higher diagnostic yield than first implanting an ICM.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of right ventricular dysfunction in patients with severe aortic stenosis treated with trans-catheter aortic valve implantation: comment and validation from a small real-world cohort.","authors":"Kaiyuan Cen, Juanyu Lin, Shixiang Yu","doi":"10.1007/s11739-025-04124-w","DOIUrl":"https://doi.org/10.1007/s11739-025-04124-w","url":null,"abstract":"<p><p>Right ventricular dysfunction is a known predictor of early mortality after TAVI. TAPSE is a practical echocardiographic index of RV function. To assess whether baseline TAPSE predicts 30-day mortality after TAVI in a real-world cohort. Among 21 patients, those with TAPSE < 17 mm had higher 30-day mortality (28.6% vs 7.1%). PASP was higher in the low-TAPSE group (45 ± 12 vs 32 ± 10 mmHg; p = 0.03). Non-survivors had a lower TAPSE/PASP ratio than survivors (median 0.351 [IQR 0.288-0.419] vs 0.607 [0.406-0.667]; exact p = 0.078), in line with a trend toward worse RV-pulmonary arterial coupling. A multivariable model including TAPSE, age, and EuroSCORE II showed apparent perfect discrimination (AUC = 1.00) within this very small dataset (3 events), likely overestimating true performance due to overfitting. TAPSE may serve as a simple, effective tool for early risk stratification in TAVI candidates as an adjunct to-rather than a replacement for-comprehensive geriatric/frailty assessment and established risk scores; estimates are unstable due to the small sample and event count.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Oral anticoagulants-related bleeding: what happens in the emergency room? The Galeno study.","authors":"Doris Barcellona, Giada Melis, Antonio Bussu, Monica Orrù, Maria Laura Caddeo, Emilia Antonucci, Antonella Mameli, Francesco Marongiu","doi":"10.1007/s11739-025-04127-7","DOIUrl":"https://doi.org/10.1007/s11739-025-04127-7","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscular polyarteritis nodosa.","authors":"Kosuke Ishizuka, Yoshiyuki Ohira, Mitsuyasu Ohta","doi":"10.1007/s11739-025-04136-6","DOIUrl":"https://doi.org/10.1007/s11739-025-04136-6","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: addressing patient exclusion and statistical concerns in atrial fibrillation latent class analysis.","authors":"Shoaib Majeed, Jie Tu","doi":"10.1007/s11739-025-04114-y","DOIUrl":"https://doi.org/10.1007/s11739-025-04114-y","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}