Internal and Emergency Medicine最新文献

{"title":"Distinct pain profiles across irritable bowel syndrome subtypes: results from the Rome Foundation Global Epidemiology Study.","authors":"Keren Hod, Giovanni Marasco, Luigi Colecchia, Ami D Sperber, Olafur S Palsson, Shrikant I Bangdiwala, Giovanni Barbara","doi":"10.1007/s11739-026-04375-1","DOIUrl":"https://doi.org/10.1007/s11739-026-04375-1","url":null,"abstract":"<p><p>Abdominal pain is the hallmark symptom of irritable bowel syndrome (IBS), yet its clinical expression varies considerably across subtypes. Despite this, few large-scale studies have compared pain features across all Rome IV-defined IBS subtypes. We aimed to delineate differences in abdominal pain patterns across IBS subtypes and evaluate the contribution of psychological comorbidities, extra-intestinal symptoms, and intermediate factors associated with psychological distress. Data were derived from the internet survey of the Rome Foundation Global Epidemiology Study, encompassing 54,127 participants from 26 countries, including 2195 IBS patients [712 constipation-predominant IBS (IBS-C), 629 diarrhea-predominant IBS (IBS-D), 712 mixed-type IBS (IBS-M), 142 unclassified-IBS (IBS-U)]. Clinical, dietary, and psychological parameters were assessed using validated questionnaires. Mediation analysis examined whether the association between IBS and psychological distress was attenuated after inclusion of illness perception, food avoidance, and work/activity impairment. IBS-C patients exhibited longer, more severe, and widespread pain, often radiating to the back and associated with greater analgesic use, while pain in IBS-D patients was linked to stool frequency and consistency changes. IBS-C patients reported greater dissatisfaction with bowel function, IBS-U patients frequently identified abdominal pain and bloating/distention as their most bothersome symptom. Psychological distress and somatic symptom burden were prevalent across all subtypes (69-78% and mean scores of 8.3-95, respectively). Mediation analyses revealed partial indirect associations of concerns about bowel function, embarrassment, and work/activity-related impairment, but not food avoidance. IBS subtypes demonstrate distinct pain and psychosocial profiles. Psychological burden is partly accounted for by illness perceptions and work/activity impairment, emphasizing importance of personalized, multimodal management strategies.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837473","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":"Real-world applicability of steatotic liver disease nomenclature: multifactorial phenotypes as an unmet classification need.","authors":"Rosanna Villani, Elisabetta Cornacchia, Gaetano Serviddio","doi":"10.1007/s11739-026-04373-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04373-3","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837480","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":"Venous thromboembolism with modern glucose-lowering agents in diabetes: active-comparator evidence beyond placebo-based meta-analyses.","authors":"Andrea Boccatonda, Chiara Simion, Alice Brighenti, Damiano D'Ardes, Fabio Piscaglia, Carla Serra, Paolo Simioni, Elena Campello","doi":"10.1007/s11739-026-04363-5","DOIUrl":"https://doi.org/10.1007/s11739-026-04363-5","url":null,"abstract":"<p><p>The influence of newer glucose-lowering agents on venous thromboembolism (VTE) risk has important therapeutic implications. This meta-analysis compared sodium-glucose cotransporter-2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) with dipeptidyl peptidase-4 inhibitors (DPP-4i) and evaluated head-to-head SGLT2i versus GLP1-RA comparisons. Eligible studies enrolled adults with diabetes and reported adjusted relative risks for VTE, pulmonary embolism (PE), or deep vein thrombosis (DVT) using new-user cohort, target-trial emulation, nested case-control, or randomized controlled designs. Pooled estimates were derived using inverse-variance meta-analysis on the log scale, with random-effects sensitivity analyses. Six studies met inclusion criteria, all of moderate risk of bias. Compared with DPP-4i, both SGLT2-i (HR 0.72; 95% CI 0.62-0.82) and GLP1-RA (HR 0.78; 95% CI 0.73-0.83) were associated with significantly reduced VTE risk, whereas no difference was observed between SGLT2-i and GLP1-RA (HR 1.02; 95% CI 0.84-1.23). Component analyses were directionally consistent: for PE, SGLT2-i versus DPP-4i HR 0.44 (95% CI 0.30-0.64) and GLP1-RA versus DPP-4i HR 0.74 (95% CI 0.68-0.82); for DVT, SGLT2-i versus DPP-4i HR 0.82 (95% CI 0.68-0.99) and GLP1-RA versus DPP-4i HR 0.81 (95% CI 0.75-0.88). In adults with diabetes, SGLT2-i and GLP1-RA were each associated with a lower risk of VTE compared with DPP-4i, while head-to-head comparisons showed no clear difference and were limited by imprecision. These findings should be interpreted with caution given the limited evidence base. Overall, they suggest that concerns regarding VTE risk should not be a primary driver of treatment selection between these agents in clinical practice.Trial registration:PROSPERO CRD4201149607.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837471","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":"Hemostasis at the edge between physiology and cancer.","authors":"Angela Galardi, Elisa Dell'Orto, Francesca Bianchi, Giulia Cosentino, Valentina Fogazzi, Serenella M Pupa, Marilena V Iorio","doi":"10.1007/s11739-026-04294-1","DOIUrl":"https://doi.org/10.1007/s11739-026-04294-1","url":null,"abstract":"<p><p>Hemostasis lies at the edge between physiology and cancer, where the coagulation cascade-initiated by tissue factor, thrombin generation, and fibrin deposition-shifts from vascular repair to tumor promotion. The interplay between coagulation and cancer is now recognized as a two-way street, with tumor cells activating the clotting system and coagulation components feeding back to promote malignancy. Tumor cells not only foster proliferation and invasion by overexpressing tissue factor and activating Protease-Activated Receptors (PAR1/PAR2) signalling, but they also induce endothelial cells and fibroblasts in the tumor microenvironment (TME) to produce coagulation factors (TF, FV, prothrombin) through cytokines (VEGF, IL-1β), NF-κB signalling, and hypoxia factor (HIF-1α). Generated thrombin and FXa drive MAPK/PI3K pathways, angiogenesis (VEGF upregulation), and immune evasion by suppressing T-cell chemokines (CXCL9/10/11) and fostering M2 macrophages. Platelets, activated by tumor-associated coagulation, release PDGF, TGF-β, and VEGF to promote stromal remodeling and exclude cytotoxic T cells via PD-L1 transfer, while fibrin matrices shield tumors and recruit suppressive myeloid cells. This bidirectional interplay creates a protumoral niche supporting both primary growth and metastatic dissemination, where circulating tumor cells (CTCs) exploit platelet cloaking against shear stress and NK cells. Cancer hypercoagulability is a known state which elevates venous thromboembolism, with D-dimer as a prognostic biomarker linking thrombosis to aggressive disease. Targeting this hemostasis-cancer axis-via TF inhibition, anticoagulation, or antiplatelet therapy-offers therapeutic promise to disrupt proliferation, immune escape, and metastasis.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837490","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":"Impact of an intensive follow-up program on the outcome of acute heart failure patients hospitalized in internal medicine versus cardiology units: a single-center retrospective cohort study.","authors":"Giulia Antonelli, Giuseppe Pinto, Alessandro Villaschi, Gaia Filiberti, Alessandro Giaj Levra, Cristina Panico, Beniamino Rosario Pagliaro, Marta Maccallini, Marta Pellegrino, Guido Del Monaco, Laura Ardino, Elena Vrinceanu, Daniela Pini, Gianluigi Condorelli","doi":"10.1007/s11739-026-04355-5","DOIUrl":"https://doi.org/10.1007/s11739-026-04355-5","url":null,"abstract":"<p><p>This study evaluates the efficacy of a post-discharge follow-up program in patients recovering from acute heart failure (AHF) hospitalized in internal medicine (IM) and in cardiology (CA) wards. Patients hospitalized for AHF between October 2020 and November 2022 at a third-level center were retrospectively analyzed according to their hospitalization ward in CA vs IM. Patients deemed eligible for inclusion were ≥ 18 years-old and hospitalized for AHF. Only patients discharged alive were included in the post-AHF follow-up program. The primary endpoint was a composite of time to first HF hospitalization or cardiovascular (CV) death at 6 months, while secondary endpoints were its individual components, all-cause death and a composite of time to first HF hospitalization or all-cause mortality at 6 months. Out of 230 patients, 122 were hospitalized in CA and 108 in IM wards. Patients hospitalized in CA were younger and less frequently affected by extra-cardiac comorbidities compared to patients managed in IM. At 6 months, no difference in the primary endpoint was registered in the two groups (IM 16.6% N = 18 vs CA 13.1% N = 16, log-rank p = 0.425; IR 37.5 per 100 p/y CI 23.7-59.6 vs 28.4 per 100 p/y CI 17.4-46.5; p = 0.523). Moreover, the cohorts did not differ for any of the secondary endpoints. A secondary analysis according both to ward of hospitalization and ejection fraction (> 40% vs ≤ 40%) did not show any significant difference in the primary composite outcome between the subgroups. In this single-center retrospective cohort study, no significant differences in the risk of major adverse CV events were observed between patients hospitalized in CA and IM wards during mid-term follow-up after enrollment in a post-AHF follow-up program.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837468","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":"Effects of smoking cessation interventions on vascular health markers: a scoping review.","authors":"Giulio Geraci, Jacob George, Giusy Rita Maria La Rosa, Yusuff Adebayo Adebisi, Jacqueline Yu, Davide Capodanno, Rohan Sequeira, Riccardo Polosa","doi":"10.1007/s11739-026-04368-0","DOIUrl":"https://doi.org/10.1007/s11739-026-04368-0","url":null,"abstract":"<p><p>This scoping review aims to map prospective evidence on the vascular effects of major smoking cessation therapies, including pharmacotherapy, nicotine replacement therapy and exclusive switching to electronic cigarettes, in adult smokers. A comprehensive search of PubMed, Scopus and Web of Science was conducted on December 2, 2025. Eligible studies included randomized controlled trials, quasi-experimental designs and prospective cohort studies reporting quantitative or narrative findings on vascular function following smoking cessation or exclusive electronic cigarette use. Only studies with at least 1 week of follow-up and resting vascular measurements were included. Data were charted using a standardized extraction template and synthesized narratively, consistent with scoping review methodology. Twenty-two prospective studies met the inclusion criteria. Pharmacotherapy-assisted cessation, nicotine replacement therapy and exclusive switching to electronic cigarettes were all associated with improvements in vascular outcomes among participants who fully abstained from combustible cigarettes. Increases in flow-mediated dilation were observed across treatment categories, with several studies reporting measurable gains within the first 3 to 12 months. Reductions in pulse-wave velocity and augmentation index also emerged in most cohorts, although effect sizes varied according to study design, follow-up duration and population characteristics. Evidence from studies on exclusive electronic cigarette use, although limited in number, showed improvements in endothelial function and arterial stiffness comparable to those observed with conventional cessation therapies. Prospective evidence indicates that multiple smoking cessation therapies, including exclusive switching to electronic cigarettes, may be associated with early improvements in vascular function when combustible cigarette exposure is fully eliminated. The evidence base remains constrained by heterogeneity, small sample sizes and short follow-up, particularly within studies on electronic cigarette switching. Larger and long-term prospective studies are needed to clarify the durability and clinical implications of these early vascular changes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814458","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":"Novel biomarkers in acute kidney injury: their role in the diagnosis of kidney dysfunction and etiology definition, their potential as predictive markers of structural renal damage severity.","authors":"Gaetano Pacinella, Maria Grazia Basso, Giuseppe Miceli, Alessandra Casuccio, Mario Daidone, Stefania Scaglione, Federica Todaro, Chiara Pintus, Giuliana Rizzo, Antonino Tuttolomondo","doi":"10.1007/s11739-026-04362-6","DOIUrl":"https://doi.org/10.1007/s11739-026-04362-6","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a life-threatening condition whose early diagnosis is crucial. The most used method to evaluate renal function is the glomerular filtration rate (eGFR). The detection of new circulating molecules has gained traction for the early identification of kidney damage. In this prospective observational study, 57 patients with acute kidney disease and 23 patients without acute renal damage were consecutively enrolled; urinary concentrations of NGAL, LFABP, CYR61, TIMP-2, IGFBP-7, and [TIMP-2 X IGFBP-7], and serum concentrations of PENK and KIM-1 were obtained in all patients. The primary endpoint was to assess the role of serum and urinary markers in distinguishing prerenal from renal pathogenesis of AKI. The secondary endpoint was to evaluate the possible association between urinary and serum concentrations of these markers and the severity of acute kidney injury. Urinary TIMP-2, NGAL, and IGFBP-7 concentrations were higher in patients with AKI compared with the control group, with statistical significance. Among patients with AKI, we found higher concentrations of LFABP, Cyr61, TIMP-2, NGAL, IGFBP-7, and [TIMP-2]x[IGFBP-7] according to AKI aetiology, with statistical significance maintained in multivariable logistic regression for IGFBP-7. The ROC curve confirmed that IGFBP-7 has a predictive role in the aetiological diagnosis of AKI. A significant association between urinary LFABP and TIMP-2 and serum KIM-1 concentrations (p = 0.0001) and the variation in creatinine values from baseline to enrollment was found. Furthermore, we found a statistically significant correlation between KIM-1 and the variation in creatinine levels from admission to discharge. This study highlights an association between the concentrations of the novel biomarkers and the aetiology of AKI, with a possible role for these molecules in stratifying patients with acute renal disease.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814544","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":"Persistent pulseless electrical activity during cardiac arrest: when should resuscitation be terminated?","authors":"Sungwook Park","doi":"10.1007/s11739-026-04374-2","DOIUrl":"https://doi.org/10.1007/s11739-026-04374-2","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837507","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":"Medial arterial calcification and refractory osteomyelitis in systemic sclerosis: a case report and literature review.","authors":"Luigi Marzano, Francesco Presa, Simone Villaboni, Giulio Luigi Bonisoli, Simonetta Friso","doi":"10.1007/s11739-026-04377-z","DOIUrl":"https://doi.org/10.1007/s11739-026-04377-z","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814423","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":"Heart involvement in alcohol use disorder: observational and retrospective study in a specialized hospital unit and long-term follow-up.","authors":"Margherita Vergadoro, Erika Zola, Giovanni Gottardi, Simona Di Liberto, Anna Chiara Frigo, Luca Fabris, Paolo Simioni","doi":"10.1007/s11739-026-04367-1","DOIUrl":"https://doi.org/10.1007/s11739-026-04367-1","url":null,"abstract":"<p><p>Although growing attention has been drawn to alcohol-related heart damage, several clinical aspects, including prevalence and outcome of alcoholic cardiomyopathy (ACM) and atrial fibrillation (AF) in patients with alcohol use disorder (AUD) remain elusive. This study investigated the clinical impact of ACM and AF on AUD patients in the setting of an internal medicine unit. We retrospectively analyzed 291 consecutive patients admitted for AUD at a single specialized center for AUD diagnosis and treatment, affiliated with an internal medicine unit. We included patients who underwent echocardiographic evaluation following hospital admission. Demographic data, comorbidities, alcohol-related organ damage, and ECG findings were collected to diagnose AF and ACM and to assess their clinical impact. Among 291 patients undergoing echocardiography and ECG, 239 were males (82.1%). They were categorized into patients with (n = 42, Group A) and without ACM (n = 249, Group B). The prevalence of ACM was 14.4%, whereas AF was found in 19.1%. ACM patients were asymptomatic in 28.6% of cases. Among comorbidities, significant differences were observed in the prevalence of type 2 diabetes (7.1% in Group A, 21.2% in Group B, p = 0.0329). Risk of mortality was significantly influenced by AF, but not by ACM. A significant proportion of AUD inpatients were diagnosed with ACM (about 14%, 95% men) and AF (19.1%, 88.9% men), which only affected mortality. Notably, more than a quarter of ACM patients were asymptomatic for heart failure supporting the value of echocardiographic assessment even when overt heart failure was absent. By survival analysis, AF rather than ACM emerged as an adverse prognostic factor. These findings support a structured cardiac evaluation in hospitalized patients with AUD.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814478","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}