Internal and Emergency Medicine最新文献

{"title":"Comparative performance of pre-interventional prognostic scores in predicting 30-day mortality and ICU admission in gastrointestinal bleeding.","authors":"Yunus Emre Yilmaz, Ozlem Bulbul, Arif Mansur Cosar, Vildan Ozer","doi":"10.1007/s11739-026-04519-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04519-3","url":null,"abstract":"<p><p>Comprehensive intra-cohort comparisons of pre-interventional prognostic scores for gastrointestinal bleeding (GIB) are lacking. We compared 12 pre-interventional scores [Glasgow-Blatchford Score (GBS), modified GBS (mGBS), AIMS65, Pre-Rockall, ABC, Harbinger, T-Score, Canuka, SHA2PE, Oakland, NOBLADS, and Modified Early Warning Score (MEWS)] for predicting 30-day mortality and intensive care unit (ICU) admission in emergency department patients with upper GIB (UGIB) and lower GIB (LGIB). This retrospective, single-center cohort study evaluated 2020 patients with GIB between January 2014 and March 2025, categorized into UGIB (n = 1524) and LGIB (n = 496) groups. Primary outcomes were 30-day mortality and ICU admission. Scores were evaluated in two ways: an indication-restricted analysis, in which each score was applied only to the bleeding location for which it was developed, and a comprehensive analysis, in which all 12 scores were applied to both subgroups. Discriminative performance was assessed using the area under the curve (AUC); the highest-performing scores per outcome were compared using DeLong's method. For 30-day mortality, AIMS65 showed the highest discrimination in UGIB (AUC = 0.850) and NOBLADS in LGIB (0.809) in the indication-restricted analysis. In the comprehensive analysis, AIMS65 again showed the highest discrimination (AUC = 0.850) in UGIB, outperforming NOBLADS (AUC = 0.812; p = 0.035), ABC (AUC = 0.801; p = 0.023), and Pre-Rockall (AUC = 0.798; p = 0.033), but not Canuka (AUC = 0.821; p = 0.124). For LGIB, GBS achieved the highest AUC (0.851), followed by MEWS (0.841) and mGBS (0.832), with no significant pairwise differences among the top five scores. For ICU admission, the highest-performing scores demonstrated moderate discrimination in the comprehensive analysis (AUC range, 0.755-0.788 in UGIB; 0.746-0.768 in LGIB). AIMS65 showed the highest discrimination for 30-day mortality in UGIB in both analyses, whereas no score demonstrated clear superiority in LGIB. NOBLADS ranked highest within its original indication in LGIB and retained strong discrimination when applied to UGIB, supporting its potential role as a location-independent mortality predictor. No score reliably predicted ICU admission, indicating a persistent gap in pre-interventional risk stratification.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891542","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":"Increased risk of incident and recurrent urinary tract infection in autosomal dominant polycystic kidney disease: a contemporary propensity score-matched cohort study.","authors":"Jui Wang, Szu-Ying Lee, Chia-Ter Chao, Kuo-Liong Chien, Kuan-Yu Hung","doi":"10.1007/s11739-026-04518-4","DOIUrl":"https://doi.org/10.1007/s11739-026-04518-4","url":null,"abstract":"<p><p>Urinary tract infection (UTI) is a clinically important complication of autosomal dominant polycystic kidney disease (ADPKD), often involving upper urinary tract and cyst infections. However, most epidemiologic data were generated decades ago, prior to contemporary advances in ADPKD management. We evaluated the current risk of incident and recurrent UTI in adults with ADPKD. Using the National Taiwan University Hospital Integrated Medical Database (2006-2021), adults with ADPKD were propensity score matched (1:4) to individuals without cystic kidney disease by age, sex, and chronic kidney disease (CKD) stage. Participants with prior UTI were excluded. Incident UTI was identified using validated International Classification of Disease codes. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) controlling for demographics, comorbidities, medications, and estimated glomerular filtration rate. Recurrent UTI (≥ 2 episodes) risk was assessed in sensitivity analyses. The cohort included 1,044 patients with ADPKD and 4,176 matched controls (mean follow-up 4.2 years). Incident UTI occurred in 17.9% of ADPKD patients and 15.6% of controls (45.96 vs. 36.24 per 1,000 patient-years). This represented an absolute difference of 2.3 percentage points. ADPKD was independently associated with increased incident UTI risk (aHR 1.20, 95% confidence internal (CI) 1.02-1.42). The association was more pronounced in males (aHR 1.59) and in CKD stages 3b-5 (aHR 1.51). ADPKD was also associated with recurrent UTI (incidence rate ratio 1.32, 95% CI 1.15-1.51). In the contemporary era, ADPKD remains independently associated with increased risk of incident and recurrent UTI, although the absolute increase in UTI incidence was moderate. Targeted surveillance and preventive strategies may be warranted in high-risk subgroups.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879985","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":"Refractory lupus nephritis: national multicenter study.","authors":"Vanesa Calvo-Río, Celia González-García, Paúl Hernández Velasco, Enrique Morales Ruiz, Raquel Ugena-García, Anne Margaret Riveros Frutos, Joaquín Belzunegui Otano, Anahy María Brandy García, Ángel García Manzanares, Jose Ramón Lama Riazuelo, Sebastián Sandoval, Josefina Cortés-Hernández, Irati Urionagüena Onaindia, Susana Gómez Castro, Sabela Fernández Aguado, Montserrat Corteguera Coro, Aaron Josué Fariña Gonzalez, María Álvarez Del Buergo, Andrés Lorenzo Martín, Irene Carrión Barberá, Luis Martín Penagos, Ricardo Blanco","doi":"10.1007/s11739-026-04510-y","DOIUrl":"https://doi.org/10.1007/s11739-026-04510-y","url":null,"abstract":"<p><p>Refractory lupus nephritis (LN) remains a major therapeutic challenge and a leading cause of progression to end-stage kidney disease (ESKD) in systemic lupus erythematosus (SLE). To characterize a large multicenter cohort of refractory LN, evaluate therapeutic strategies used after non-response, and determine long-term renal outcomes. Multicenter longitudinal cohort including 68 patients with refractory LN from several Spanish centers. Refractoriness was defined according to the GLOSEN consensus as failure to reduce proteinuria by  > 25% or worsening of proteinuria and/or renal function after ≥3 months of triple immunosuppressive therapy. Demographic, clinical, histological, therapeutic and outcome data were collected. The cohort included 68 patients (61 women), mean age 34.5 [27-45] years. Renal biopsy showed predominantly proliferative classes (III-IV and mixed forms). Extrarenal involvement was frequent, mainly articular (82.3%), hematological (70.6%) and cutaneous (60.3%). Before non-response, most patients had received corticosteroids (98.5%), mycophenolate mofetil (82.3%), antimalarials (91.2%) and cyclophosphamide (36.8%). Non-response occurred after 16.1  ±  9.5 months and was due to persistent proteinuria (61.8%), worsening renal function (25%) or both (13.2%). Over 12 months, creatinine remained stable, from 0.96 to 1.02 mg/dL (p = 0.726), C3 increased from 56.3 to 85.55 mg/dL (p < 0.001), C4 rose from 0.82 to 1.02 mg/dL (p < 0.001), while proteinuria decreased from 1.9 ± 0.5 to 0.57 ± 0.24 g/24 h (p < 0.001). After treatment modification or intensification-including tacrolimus (39.7%), rituximab (27.9%) and belimumab (27.9%), 41 patients (60.3%) achieved LN remission during a mean follow-up of 59.7 ± 46 months. Ten patients progressed to ESKD (6 requiring hemodialysis and 4 undergoing kidney transplantation). Infections were the most frequent complication (30.9%). Therapeutic escalation allowed LN remission in a substantial proportion patients with refractory LN; however. the risk of progression to ESKD remained high. These findings highlight the need for earlier recognition of non-response and more effective treatment strategies to prevent irreversible renal damage.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880007","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":"Klippel-Trénaunay syndrome presenting with recurrent superficial thrombophlebitis.","authors":"Nicola Mumoli, Davide Dionisi, Arianna Antonacci, Aldo Fici, Maridelia Ambrosecchia","doi":"10.1007/s11739-026-04516-6","DOIUrl":"https://doi.org/10.1007/s11739-026-04516-6","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880037","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":"Unsupervised machine learning with Cluster Analysis in patients with rheumatoid arthritis: insights in CV risk phenotypes from a multicentre Italian cohort.","authors":"Vincenzo Venerito, Elena Bartoloni, Gian Luca Erre, Matteo Piga, Garifallia Sakellariou, Ombretta Viapiana, Andreina Manfredi, Elisa Gremese, Fabiola Atzeni, Francesca Romana Spinelli, Fabio Cacciapaglia","doi":"10.1007/s11739-026-04478-9","DOIUrl":"https://doi.org/10.1007/s11739-026-04478-9","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) patients face increased cardiovascular (CV) risk, yet existing 10-year estimation tools often underperform. This study evaluated whether unsupervised machine learning (uML) clustering can identify distinct RA patient phenotypes with varying major cardiovascular events (MACE) potentially improving risk stratification. A cross-sectional, multi-center cohort of RA patients meeting the 2010 ACR/EULAR classification criteria and without prior CV events was enrolled in January 2019 and followed-up for MACE incidence over 5 years. Clinical and demographic data, including traditional CV risk factors and SCORE2 estimates, were collected. Factor Analysis of Mixed Data (FAMD), a generalization of principal component analysis for mixed data types, was applied in Python (ver.3.9) using Prince (ver.0.7.1). Missing data observations were excluded. Bootstrapped eigenvalue distribution determined the number of FAMD components for clustering, followed by Hierarchical Clustering on Principal Components using Ward's criterion and Euclidean distance. An XGBoost model assessed feature importance, while ANOVA and Chi-square tests evaluated cluster differences. Among 951 RA patients (mean age 61.8 ± 10.5 years; 81.1% female; median disease duration 120 months), 9 MACE occurred (incidence: 1.89/1000 patient-years). Four clusters emerged: Cluster 1 (high HAQ, steroid use, high cholesterol), Cluster 2 (low disease activity, BMI, diabetes, hypertension, SCORE2), Cluster 3 (predominantly male, < 10-year disease duration, csDMARDs; no MACE cases), and Cluster 4 (longer disease duration, hypertension, high triglycerides, lipid-lowering agents, TNFi; highest MACE incidence).uML clustering identified distinct RA phenotypes, complementing SCORE2 for improved CV risk stratification and aiding in recognizing patients at elevated MACE risk.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879999","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":"A splanchnic venous thrombosis revealing Biermer's disease: a case report.","authors":"Abdelghani Bachir Cherif, Salam Bennouar, Sara Benzaamia, Yousra Djebbar, Elayadi Nazli","doi":"10.1007/s11739-026-04347-5","DOIUrl":"10.1007/s11739-026-04347-5","url":null,"abstract":"<p><p>Biermer's disease, or pernicious anemia, is an autoimmune condition marked by vitamin B12 deficiency due to intrinsic factor antibodies targeting gastric parietal cells. The relationship between Biermer's disease and increased thrombotic risk, while uncommon, represents a critical clinical concern necessitating heightened diagnostic awareness for patients presenting with unexplained thrombotic symptoms. This report details the case of a 57-year-old Mediterranean male, with a prior diagnosis of Graves' disease, who developed splanchnic venous thrombosis. An extensive etiological investigation revealed mild hyperhomocysteinemia, associated with an undiagnosed Biermer's disease. Our case underscores a critical association between Biermer's disease, hyperhomocysteinemia, and venous thrombosis, emphasizing the imperative for further research elucidating their interconnected pathogenesis.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2201-2205"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638851","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":"What is your next step? A case of a composite dyslipidemia with atherosclerotic trajectory: bridging primary care to internal medicine setting.","authors":"Marco Prastaro, Maria Maddalena Grattagliano, Oleg Kats, Antinisca Pignatiello, Piero Portincasa","doi":"10.1007/s11739-026-04376-0","DOIUrl":"10.1007/s11739-026-04376-0","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2207-2209"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868309","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":"Euglycemic ketoacidosis in a nondiabetic patient with Duchenne muscular dystrophy on dapagliflozin: comment.","authors":"Claudia Stöllberger, Josef Finsterer","doi":"10.1007/s11739-026-04328-8","DOIUrl":"10.1007/s11739-026-04328-8","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2355-2356"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485743","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":"Integrated POCUS-driven hemodynamic management in septic shock: a clinical note.","authors":"Diamante Quarantelli, Claudio Giumelli, Paolo Montanari, Aderville Cabassi","doi":"10.1007/s11739-026-04465-0","DOIUrl":"10.1007/s11739-026-04465-0","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2331-2333"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591544","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":"The effect of fascial block on opioid consumption in patients with multiple rib fractures: a retrospective observational study.","authors":"Sossio Serra, Domenico Pietro Santonastaso, Giuseppe Romano, Alessandro Riccardi, Francesca Ortu, Vanni Agnoletti, Mario Guarino, Claudia Sara Cimmino, Michele Domenico Spampinato, Michela Cascio, Raffella Francesconi, Fabio De Iaco","doi":"10.1007/s11739-025-04144-6","DOIUrl":"10.1007/s11739-025-04144-6","url":null,"abstract":"<p><p>Pain is a common feature in multiple rib fractures. Opioids are the mainstay of analgesic therapy due to their high efficacy, however, can lead to a reduction in respiratory rate and tidal volume, sedation and respiratory failure. Fascial blocks can provide safe, adequate analgesia with only local effects. This study aims to investigate the effect of fascial block on the reduction of total opioid consumption. A retrospective observational study, conducted in the emergency medicine unit (EMU), including all adult, opioid-naïve patients admitted between January 2022 and August 2024 with post-traumatic blunt chest trauma. 103 patients, 26 (27.9%) women, with a median age of 62 years (IQR 56-76), a median Thoracic Trauma Severity Score (TTSS) of 8 (IQR 7-9), a median pain score of 8 on the 0-10 Numeric ranking scale, and 66 patients (60.2%) underwent fascial block. Median total opioid consumption was 92 morphine milligram equivalents (IQR 61.5-140), significantly lower in patients undergoing fascial block (71 (IQR 60-101) vs. 150 (110-210), p < 0.001), despite higher pain on admission (8 (IQR 7-9) vs. 6 (IQR 5-7), p < 0.01), with better pain control and no differences in total length of stay, TTSS or number of rib fractures. This study shows that fascial blocks in patients admitted to the EMU for post-traumatic pain due to multiple rib fractures are associated with a significant reduction in overall opioid consumption and no specific complication, supporting the use of a multimodal approach for better pain control.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2241-2249"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}