Internal and Emergency Medicine最新文献

{"title":"Burden, features and factor associated with disorders of gut-brain axis in Italy: results from the Rome foundation global epidemiology study.","authors":"Giovanni Marasco, Keren Hod, Luigi Colecchia, Cesare Cremon, Enrico Stefano Corazziari, Ami David Sperber, Olafur Steinn Palsson, Shrikant Ishver Bangdiwala, Giovanni Barbara","doi":"10.1007/s11739-026-04350-w","DOIUrl":"https://doi.org/10.1007/s11739-026-04350-w","url":null,"abstract":"<p><p>Disorders of gut-brain interaction (DGBI) are prevalent and burdensome conditions. This study aimed to assess the prevalence, regional distribution, and associated factors of DGBI in Italy, and compare findings with the rest of Europe. Data were drawn from the Rome Foundation Global Epidemiology Study. A representative sample of 2063 Italian adults completed a internet-based questionnaire assessing DGBI presence, psychological distress, somatic symptoms, dietary habits, and healthcare utilization. Comparative analysis was conducted within the country and with other European countries. Multivariate logistic regression identified independent associated factors in Italy. Overall, 44.2% of Italian participants met criteria for at least one DGBI with higher prevalence in women and individuals aged 18-39 years. The South and Islands showed the highest DGBI prevalence. Functional constipation (13.9%) and functional dyspepsia (9.1%) were the most common DGBI, while irritable bowel syndrome affected 5.0% of the population. Psychological distress, somatic symptom burden, female sex, and younger age were independently associated with DGBI, while living in small rural communities showed an inverse association. Compared to the rest of Europe, Italy showed higher DGBI rates across multiple gastrointestinal regions and more frequent overlapping DGBI. DGBI represent a substantial burden in Italy compared with the rest of Europe, with marked regional and psychosocial gradients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770626","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":"Risk factors for oral and esophageal candidiasis during budesonide treatment in eosinophilic esophagitis patients.","authors":"Irene Spinelli, Maria Parmigiani, Francesca Fianchi, Arianna Aruanno, David Longhino, Federica Castri, Cristiano Caruso, Francesca Romana Ponziani, Maria Elena Riccioni, Gianluca Ianiro, Antonio Gasbarrini","doi":"10.1007/s11739-026-04324-y","DOIUrl":"https://doi.org/10.1007/s11739-026-04324-y","url":null,"abstract":"<p><p>Eosinophilic esophagitis (EoE) first-line therapy is represented by budesonide orodispersible tablets (BOT), but a very low number of patients develop oral and esophageal candidiasis. The aim of the study is to evaluate risk factors for the development of oral and esophageal candidiasis during budesonide therapy in EoE patients. A retrospective study was conducted to include all EoE patients in BOT therapy referred to our center. Prevalence, localization, and time of presentation of candidiasis, eosinophilic count in gastroscopy before BOT therapy, and concomitant treatment with proton pump inhibitors (PPI) and its dosage were reviewed. A total of 46 EoE patients in BOT therapy were included in the study. 7 patients (15%) developed oral and/or esophageal candidiasis. 4 patients (57%) of this group were in concomitant PPI therapy, all at 40 mg per day or more dosage, whereas 38% of patients without mycosis were taking this medication (41% at 40 mg per day or more). The mean eosinophil count before treatment was 45/HPF in patients with candidiasis infection and 33/HPF for the others without. Concomitant PPI therapy and high eosinophilic count may represent risk factors in developing mycosis in EoE patients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770606","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 burden of smoking-related gastrointestinal cancers from 1990 to 2021 and projections to 2050: findings from the global burden of disease study 2021.","authors":"Zhou Xu, Yong Song, Beibei Wang, Juan Liu","doi":"10.1007/s11739-026-04304-2","DOIUrl":"https://doi.org/10.1007/s11739-026-04304-2","url":null,"abstract":"<p><p>Gastrointestinal (GI) cancers are among the most deadly cancers globally, with smoking being a significant risk factor. This study analyzes the burden of smoking-related GI cancers from 1990 to 2021 using data from the Global Burden of Disease (GBD) Study 2021 and projects trends to 2050. Estimates of smoking-related GI cancers were obtained from the Global Health Data Exchange (GHDx). These estimates represent deaths specifically attributable to smoking, derived from a multi-step modelling process combining smoking prevalence, relative risks, and total cancer mortality across 204 countries and territories, and are substantially lower than total cancer deaths. The burden was assessed using the age-standardized death rates (ASDRs) and its estimated annual percentage changes (EAPCs) across global, regional, and socioeconomic levels. Predictive analysis was conducted using a Bayesian Age-Period-Cohort (BAPC) model. In 2021, among smoking-related GI cancers, esophageal cancer had the highest global number of deaths (205,463), followed by stomach cancer (107,926), pancreatic cancer (72,170), liver cancer (53,054), and colon/rectum cancer (47,613). ASDRs and deaths were higher in males than females, peaking after age 65. From 1990 to 2021, ASDRs decreased for all smoking-related GI cancers, with the largest declines in stomach cancer (EAPC: - 2.63%) and esophageal cancer (EAPC: -1.38%). However, geographical and socioeconomic variations were evident. By 2050, deaths from various smoking-related GI cancers are projected to rise, with the ASDRs increasing for esophageal cancer but decreasing for stomach, colon/rectum, liver, and pancreatic cancers. Although the ASDRs of smoking-related GI cancers have declined, disparities persist across age, sex, geographical and development levels. Continued efforts to reduce smoking prevalence are essential to prevent further increases in GI cancer burden and improve global health outcomes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770575","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":"Closed-loop protocol for inferior vena cava filter management significantly improves retrieval: a competing-risk analysis of a 10-year cohort.","authors":"Víctor Manuel Martínez-Castilla, Elena Rodríguez-Llamas, Ana de-Miguel-Álvarez, Marina López-Rubio, Marta Olimpia Lago-Rodríguez, Rubén Alonso-Beato, Arturo Álvarez-Luque, Enrique Calleja-Cartón, Lucía Ordieres-Ortega, Sergio Moragón-Ledesma, Pablo Demelo-Rodríguez, Luis A Alvarez-Sala-Walther, Francisco Galeano-Valle","doi":"10.1007/s11739-026-04361-7","DOIUrl":"https://doi.org/10.1007/s11739-026-04361-7","url":null,"abstract":"<p><p>Inferior vena cava (IVC) filters are indicated only in acute venous thromboembolism (VTE) with an absolute contraindication to anticoagulation and should be retrieved once anticoagulation can be resumed. However, real-world retrieval rates remain low and highly variable. The objective is to assess whether implementing an institutional protocol improved appropriateness of IVC-filter placement and retrieval rates at 90 and 180 days, and to evaluate safety outcomes. Retrospective pre-post single-center study including adults who received an IVC filter between January 2015 and July 2025. Co-primary outcomes were appropriateness at placement (acute VTE ≤ 30 days plus absolute contraindication to anticoagulation) and retrieval, evaluated at 90 and 180 days using Fine-Gray competing-risk models. Among 234 patients (pre n = 182; post n = 52), cancer prevalence was similar (40.1% vs 38.5%). Appropriateness increased from 74.7% to 88.5% (risk ratio 1.18, 95% CI 1.04-1.35; p = 0.036). Retrieval improved at day 90 (41.2% → 65.4%, p = 0.020) and at day 180 (41.8% → 73.1%, p < 0.001). In Fine-Gray models, the post-protocol period was associated with a higher cumulative incidence of retrieval (adjusted sub-HR 1.68 [1.16-2.43] at 90 days; 1.92 [1.39-2.66] at 180 days), consistent with cause-specific Cox estimates. Procedure-related complications did not increase. Although overall mortality was unchanged, retrieval was independently associated with lower 180 days (adjusted HR 0.20 [0.08-0.48]). Implementing a closed-loop, guideline-aligned protocol improved appropriateness and substantially increased IVC-filter retrieval without compromising safety. Older age and active cancer remained barriers to retrieval, highlighting priority groups for targeted follow-up strategies.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770618","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":"Long-term treatment with denosumab in patients with celiac disease and osteoporosis at high risk of fracture: a retrospective study.","authors":"Jessica Pepe, Luciano Colangelo, Rachele Santori, Marco Occhiuto, Daniele Diacinti, Evaristo Ettorre, Giovambattista Desideri, Salvatore Minisola, Cristiana Cipriani","doi":"10.1007/s11739-026-04360-8","DOIUrl":"https://doi.org/10.1007/s11739-026-04360-8","url":null,"abstract":"<p><p>Patients with celiac disease have lower bone mineral density (BMD) and higher incidence of fractures compared to age- and sex-matched controls. There are no studies of denosumab, an antiresorptive drug, which is a fully human monoclonal antibody that binds the receptor activator of NFκB ligand (RANKL) in celiac patients with osteoporosis. The aim is to study the long-term effect of denosumab on BMD in celiac patients with osteoporosis on a gluten-free diet (GFD), compared to non-celiac osteoporotic patients. Fifteen celiac patients with osteoporosis and control subjects of the same age, sex, BMI, and fragility fractures were enrolled. At baseline, each patient underwent biochemical tests, spine X-ray, and DXA measurements, and the Charlson Comorbidity Index (CCI) was computed. At each visit (every 2 years ± 6 months), with a follow-up of 4 years, any adverse events or new clinical fractures, DXA measurements, and CCI were recorded. In celiac patients, a statistically significant median delta increase in total hip T-score of 0.11 compared to baseline was observed (ANOVA p< 0.05), while in the control group, it was 0.07 (ANOVA p < 0.05), with no difference between groups. New fractures occurred in the celiac group in five patients during the follow-up, and in two patients in the control group (p = 0.38). No adverse events occurred during follow-up. In celiac patients with osteoporosis on GFD, denosumab, with up to 4 years of follow-up, increased hip BMD without adverse events.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770642","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":"Posture-dependent unilateral lung injury following carbon dioxide exposure.","authors":"Miku Horikoshi, Tomotaka Takanosu","doi":"10.1007/s11739-026-04344-8","DOIUrl":"https://doi.org/10.1007/s11739-026-04344-8","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770635","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 weight of mentorship.","authors":"Tommaso Bellini","doi":"10.1007/s11739-026-04366-2","DOIUrl":"https://doi.org/10.1007/s11739-026-04366-2","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770645","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":"Echocardiographic prediction of functional coronary stenosis: global longitudinal strain as a key determinant of quantitative flow ratio.","authors":"Xiaolei Liu, Wenyuan Dong, Zirui Wu, Ruiping Lei, Wanjun Liu, Yujian Liu","doi":"10.1007/s11739-026-04364-4","DOIUrl":"https://doi.org/10.1007/s11739-026-04364-4","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the independent and combined value of global longitudinal strain (GLS) and global work efficiency (GWE) for predicting quantitative flow ratio (QFR) in patients with ischemic heart disease (IHD).</p><p><strong>Methods: </strong>In a prospective study of 222 patients with stable IHD, all participants underwent coronary angiography with QFR analysis and comprehensive 2D speckle-tracking echocardiography. LASSO regression for variable selection, multivariable logistic regression for association analysis, restricted cubic splines for non-linearity assessment, and SHAP analysis for model interpretation were employed.</p><p><strong>Results: </strong>Patients with normal QFR (≥ 0.80) showed significantly better GLS (-17.84 ± 2.34% vs -14.47 ± 2.65%, P < 0.01) and GWE (94.00[91.00-95.00]% vs 91.00[88.00-93.00]%, P < 0.01) compared to those with abnormal QFR. LASSO regression identified both GLS (OR = 2.45, 95%CI 1.82-3.30) and GWE (OR = 1.31, 95%CI 1.15-1.50) as remaining independently associated with normal QFR after full adjustment. Both relationships demonstrated significant non-linearity (P < 0.05). GLS alone showed excellent diagnostic accuracy (AUC = 0.862), while adding GWE provided only marginal improvement (AUC = 0.872, P = 0.15). SHAP analysis confirmed GLS as the most important predictor, with good model generalizability (AUC = 0.838) upon validation.</p><p><strong>Conclusion: </strong>GLS is a powerful independent predictor of coronary hemodynamics assessed by QFR in IHD patients. Although GWE shows an independent association, its incremental value beyond GLS is limited, establishing GLS as the primary echocardiographic parameter for non-invasive stratification of functionally significant coronary artery disease.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770584","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 body speaks before the doctor listens.","authors":"Rony Kurniawan Pratama","doi":"10.1007/s11739-026-04365-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04365-3","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770632","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":"Response to dual anti-impulse and lipid-lowering therapy is associated with clinical outcomes in chronic type B aortic syndrome.","authors":"Paolo Bima, Patrizia Ferrera, Elvira Fanelli, Francesco Revello, Michele La Torre, Emanuele Pivetta, Mauro Rinaldi, Fabio Verzini, Enrico Lupia, Fulvio Morello","doi":"10.1007/s11739-026-04348-4","DOIUrl":"https://doi.org/10.1007/s11739-026-04348-4","url":null,"abstract":"<p><p>Chronic type B aortic syndrome (cTBAS) is a rare condition characterized by persistent dissection, intramural hematoma or penetrating ulcer within the thoracic descending or thoraco-abdominal aorta. In cTBAS, pathological aortic remodeling leads to a high burden of morbidity and mortality. Guidelines recommend medical treatment with anti-impulse (AI) and lipid-lowering (LL) drugs to improve outcomes, but underlying evidence is sparse, trials are lacking, and feasibility is unknown. We performed a retrospective observational study on consecutive patients with cTBAS followed in a medical clinic from 2021 to 2025, while receiving dual AI/LL therapy with guideline-compliant targets. Response to medical therapy and occurrence of major aortic events (MAEs) were recorded. Thirty-five patients with cTBAS (23 with aortic dissection, 10 with intramural hematoma, and 2 with penetrating aortic ulcer) were followed for a median of 28 months. A MAE occurred in 11 (31%) patients. Demographic and clinical characteristics including systolic/diastolic blood pressure (SBP/DBP), heart rate and lipid levels at baseline were similar in patients who did or did not develop MAEs. During follow-up, patients without MAEs had significant reductions in SBP (P = 0.005), total and LDL cholesterol (P = 0.002, P < 0.001), and increased achievement of SBP < 130 mmHg (P = 0.046), and LDL cholesterol < 70 or < 55 mg/dL (P < 0.001, P = 0.003). All variables were statistically unchanged in patients who developed MAEs. On-target SBP at 6 months and LDL cholesterol at 12 months were associated with protection from MAEs (hazard ratio 0.19, P = 0.014, and 0.15, P = 0.004, respectively). In conclusion, results provide proof-of-concept that in cTBAS, strict dual AI/LL medical therapy is feasible and associated with favorable outcomes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728901","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}