Internal and Emergency Medicine最新文献

{"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}

{"title":"What is your next step? A case of tachyarrhythmia with an unexpected, but preventable clinical evolution: comment.","authors":"Lucio Giuseppe Granata, Nicola Ferrara, Marcello Marchetta, Giuseppina Maura Francese, Simona Giubilato","doi":"10.1007/s11739-026-04307-z","DOIUrl":"https://doi.org/10.1007/s11739-026-04307-z","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722705","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 illusion of choice: financial toxicity and the paradox of systemic therapy in advanced HCC within resource-limited settings.","authors":"Hassan Aziz, Nawal Adnan, Muhammad Junaid Patel","doi":"10.1007/s11739-026-04356-4","DOIUrl":"https://doi.org/10.1007/s11739-026-04356-4","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716370","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":"Efficacy, tolerability, and safety of 1.5L-lactulose as bowel preparation for patients with inflammatory bowel disease: a randomized, single-blinded trial.","authors":"Ye Fang, Luyan Fang, Dingyuan Hu, Xiaoxiao Shao, Guolong Ma, Yuan Xu, Yi Jiang, Daopo Lin","doi":"10.1007/s11739-026-04358-2","DOIUrl":"https://doi.org/10.1007/s11739-026-04358-2","url":null,"abstract":"<p><strong>Background: </strong>Lactulose is a novel laxative with low volume and excellent tolerability. It used as a bowel preparation for colonoscopy has so far limited application. We compared the effectiveness, tolerability, and safety of lactulose with those of polyethylene glycol (PEG) in bowel preparation of patients with inflammatory bowel disease (IBD).</p><p><strong>Methods: </strong>We enrolled 140 patients with clinically inactive IBD who required colonoscopy and randomly divided them into the 3L-PEG group or the 1.5L-Lactulose group. Bowel cleansing was assessed using the Boston Bowel Preparation Scale. The tolerability and satisfaction of the bowel preparation methods were evaluated using self-administered questionnaires. Safety was assessed by monitoring electrolytes, and liver and kidney functions in partial patients.</p><p><strong>Results: </strong>The successful bowel preparation rate was higher in the Lactulose group than in the PEG group (92.9% versus 81.4%, P = 0.0434). According to the multivariable analyses, the male sex was an independent risk factor of efficacy. The responses to self-administered questionnaires revealed that the Lactulose group experienced significantly better taste and had a higher willingness to repeat the same regimen than the PEG group (P < 0.0001). In the Lactulose group, most patients who had used PEG before could better evaluate lactulose (P < 0.0001). No significant differences in adverse events and safety were between the two groups (P > 0.05). The multivariable analyses revealed age was an independent factor of adverse events.</p><p><strong>Conclusions: </strong>1.5L-Lactulose had a higher bowel cleansing success rate and higher tolerability with acceptable safety than 3L-PEG. Therefore, 1.5L-Lactulose may be a potential option for bowel preparation in inactive IBD patients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716842","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":"Efficacy and tolerability of generic pirfenidone after switch from Esbriet^® in idiopathic pulmonary fibrosis: a real-world observational study.","authors":"Roberto Tonelli, Maria Giulia Turchiano, Antonio Moretti, Dario Andrisani, Filippo Gozzi, Giulia Raineri, Anna Valeria Samarelli, Federica Andolfi, Valentina Ruggieri, Enrico Clini, Stefania Cerri","doi":"10.1007/s11739-026-04343-9","DOIUrl":"https://doi.org/10.1007/s11739-026-04343-9","url":null,"abstract":"<p><strong>Background: </strong>Generic formulations of pirfenidone are increasingly adopted in idiopathic pulmonary fibrosis (IPF), yet real-world evidence supporting their clinical equivalence to the originator remains limited. We aimed to evaluate whether switching from branded pirfenidone (Esbriet^®) to a generic formulation affects treatment efficacy or tolerability.</p><p><strong>Methods: </strong>We conducted a retrospective, within-patient observational study including consecutive patients with IPF treated with Esbriet^® for ≥ 6 months before switching to generic pirfenidone. Pulmonary function was assessed at three time points: 6 months before the switch (T - 6), at switch (T0), and 6 months after (T + 6). The primary endpoint was the within-patient percentage change in FVC over two consecutive 6-month periods (T - 6 → T0 vs T0 → T + 6), analysed within a pre-specified equivalence framework (± 5 percentage points). Secondary endpoints included DLCO changes and treatment-related adverse events (AEs), analysed at the patient level using paired comparisons.</p><p><strong>Results: </strong>Sixty-five patients (median age 77.0 years [72.3-80.0] years, 78% male) had complete functional follow-up. The mean percentage decline in FVC was - 1.9% before the switch and - 1.7% after the switch. The estimated between-period difference in FVC change was 0.2 percentage points (95% CI - 1.1 to 1.5), fully contained within the pre-specified equivalence margins. Similar findings were observed for DLCO, with no significant difference between periods. Overall, 43% of patients experienced at least one AE during treatment. Gastrointestinal AEs were the most frequent, but paired analyses showed no significant difference in patient-level AE occurrence between branded and generic periods. No severe AEs or treatment discontinuations were observed.</p><p><strong>Conclusions: </strong>In this real-world cohort of patients with IPF, switching from branded to generic pirfenidone was not associated with clinically meaningful differences in lung function decline or treatment tolerability.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698532","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":"Sex differences in vascular endothelial function in predicting cardiovascular events in hypertensive patients.","authors":"Maria Perticone, Raffaele Maio, Edoardo Suraci, Elena Succurro, Francesco Andreozzi, Francesco Perticone","doi":"10.1007/s11739-026-04311-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04311-3","url":null,"abstract":"<p><p>The prevalence of cardiovascular morbidity and mortality is higher in females than in males, probably for different pathogenetic mechanisms operating in the onset and progression of atherosclerotic vascular disease. Endothelial dysfunction is also recognized as an important and independent predictor of cardiovascular events. Thus, we designed this study to detect possible differences in endothelial function between sexes and their effect on cardiovascular prognosis. We enrolled 844 Caucasian hypertensives (451 males and 393 females, aged 49.5 + 10.9 years). Endothelial function was investigated by strain-gauge plethysmography. Compared with males, females showed a significantly lower endothelium-dependent vasodilation (acetylcholine-stimulated peak percent increase 268  ± 1113 vs 309 ± 108% increase from basal). During the follow-up period of 9.3 ± 3.2 years, 252 new fatal and non-fatal cardiovascular outcomes (3.20%) occurred: 151 coronary (1.92%), 61 cerebrovascular (0.77%), and 40 deaths (0.51%), with a higher incidence in females than in males [MACE (3.79 vs 2.68%; P = 0.001) and coronary events (2.24 vs 1.69%; P = 0.035), cerebrovascular events (0.93 vs 0.64%; P = 0.135) and all-cause mortality (0.63 vs 0.40%; P = 0.155)]. In multivariate Cox regression analysis, endothelial function resulted an independent predictor of MACE (HR = 0.82; 95% CI 0.73-0.952) and coronary events (HR = 0.81; 95% CI 0.69-0.95), together with hs-CRP, age, LDL-cholesterol and triglyceride in the whole population, and in females and males, separately. These results were also confirmed in ROC analysis, that demonstrated a different cut-off value of endothelial function between groups (275% for males, 214% for females). Our results confirm, in hypertensive patients, the existence of significant differences between sexes in the occurrence of cardiovascular events, probably attributable to a lower vasodilating property of vascular endothelium in females.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716060","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":"Inflammatory bowel disease burden in China and the United States from 1990-2023 and prediction to 2050.","authors":"Bowen Cheng, Jing Yan, Yunfeng Huang, Jiasheng Fang, Xiaojiang Zhou, Xiaoyan Chen","doi":"10.1007/s11739-026-04352-8","DOIUrl":"https://doi.org/10.1007/s11739-026-04352-8","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) shows divergent epidemiological trends in China and the United States, necessitating country-specific forecasting approaches. This study compares IBD burden between both countries from 1990 to 2023 and projects future trends to 2050 using a multi-algorithm forecasting framework.</p><p><strong>Methods: </strong>We analyzed data from the Global Burden of Disease Study 2023 (GBD 2023) for IBD incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression was used to characterize temporal trends, and the intrinsic estimator method was applied for age-period-cohort (APC) analysis. Future projections employed ten forecasting algorithms spanning traditional time series models, machine learning, and deep learning architectures, with optimal model selection for each country-measure combination based on cross-validation mean absolute percentage error (MAPE).</p><p><strong>Results: </strong>Between 1990 and 2023, China experienced a rise in age-standardized incidence from 0.75 to 1.41 per 100,000 (average annual percentage change [AAPC] = 1.93%) alongside declining mortality (AAPC =  - 2.55%). In contrast, the United States maintained relatively stable incidence (AAPC = 0.32%) but saw increasing death rates (AAPC = 1.71%). APC analysis revealed declining cohort effects in both countries, with steeper declines observed in China. The optimal forecasting model varied by country and measure: ElasticNet was most frequently selected for age-standardized rate projections, while Prophet and Holt's damped trend models performed best for absolute case number projections. By 2050, China's age-standardized incidence and prevalence rates are projected to increase (1.69 and 11.50 per 100,000, respectively), while death and DALY rates are projected to decline (0.22 and 4.12 per 100,000). For the United States, age-standardized rates are projected to remain relatively stable or decline modestly, while absolute case numbers are projected to increase substantially (prevalent cases: 1,208,253; deaths: 10,328), driven by population growth and aging.</p><p><strong>Conclusions: </strong>China's IBD burden is characterized by rising incidence and prevalence alongside declining mortality, while the United States faces increasing absolute disease burden driven primarily by demographic change. The multi-algorithm forecasting approach, with country- and measure-specific model selection, accommodates the heterogeneous epidemiological patterns observed between these two countries.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690024","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":"Circadian troponin dynamics reveal sex-specific signals for acute coronary syndrome evaluation.","authors":"Joshua Emakhu, Sana Soman, Kegham Hawatian, Jasreen Gill, Bernard Cook, James McCord, Joseph Miller","doi":"10.1007/s11739-026-04341-x","DOIUrl":"https://doi.org/10.1007/s11739-026-04341-x","url":null,"abstract":"<p><p>High-sensitivity cardiac troponin (hs-cTn) exhibits circadian variation, yet whether these variations differ by sex and influence early risk stratification for suspected acute coronary syndrome (ACS) is uncertain. We performed a secondary analysis of the RACE-IT stepped-wedge randomized trial across nine Michigan emergency departments (July 2020-April 2021). From the 32,609 patients in the primary trial, we analyzed those with available hs-cTnI values, time-stamped, that fell within the indeterminate range (4-18 ng/L) and were performed with the Beckman Coulter assay. We performed cosinor regression models to evaluate diurnal variation and multivariable logistic regression to analyze the association with 30-day major adverse cardiac events (MACE) after adjusting for cardiovascular risk factors. Median age was 57 years; 42% were men. Men showed a higher Midline Estimating Statistic of Rhythm (MESOR) hs-cTnI (6.3 ng/L vs 5.5 ng/L; p < 0.001) and greater diurnal amplitude (β = 0.21 vs 0.13; p < 0.001). Peak concentrations occurred at 6:06 AM in both sexes. In multivariable analysis, male sex (adjusted odds ratio [aOR] 2.37, 95% CI 1.68-3.34) and earlier presentation time (per 6-h interval closer to midnight: aOR 0.65, 95% CI 0.54-0.79) independently predicted 30-day MACE. Each 1 ng/L increase in hs-cTnI conferred a 7% higher MACE risk (OR 1.07, 95% CI 1.03-1.12). hs-cTnI exhibits sex-specific circadian patterns with independent prognostic significance. These findings support the potential for time- and sex-adjusted hs-cTnI thresholds to improve early risk stratification in emergency care.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698468","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":"FIB-4 predicts coronary disease and early outcomes in unstable angina pectoris.","authors":"Sercan Dolkundari, Selen Acehan, Salim Satar, Muge Gulen, Sarper Sevdimbas, Mehmet Gorur, Kadir Nigiz","doi":"10.1007/s11739-026-04357-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04357-3","url":null,"abstract":"<p><p>Unstable angina pectoris (UAP) remains a frequent cause of emergency department (ED) admissions and carries a substantial risk of progression to myocardial infarction or major adverse cardiac events (MACE). Traditional risk scores may inadequately capture underlying systemic inflammation and fibrotic burden. The Fibrosis-4 (FIB-4) index, originally developed for non-invasive liver fibrosis assessment, has recently been linked to cardiovascular risk. The objective is to investigate the association between the FIB-4 index and angiographic coronary artery disease and short-term major adverse cardiovascular events in emergency department patients presenting with unstable angina pectoris. This prospective observational study included 262 adults diagnosed with UAP who underwent coronary angiography. Patients were categorized as having normal coronaries (Group 1) or CAD (Group 2). Demographic features, laboratory values, echocardiographic parameters, and clinical outcomes were recorded. Independent predictors of CAD were identified using binary logistic regression. Thirty-day MACE was assessed. CAD was present in 67.6% of patients. FIB-4 > 3.25 was independently associated with angiographic CAD (OR: 9.71; 95% CI 1.22-77.48; p = 0.032), along with higher triglyceride levels, lower HDL, and reduced LVEF. During follow-up, MACE occurred in 11.5% of patients and was significantly more frequent among those with FIB-4 > 3.25 (p < 0.001). No significant differences were observed in GRACE and HEART scores between patients with and without MACE. An FIB-4 > 3.25 was independently associated with the presence of angiographic CAD and a higher rate of short-term MACE in patients presenting with unstable angina pectoris. As a simple, inexpensive, and readily available biomarker, FIB-4 may provide complementary clinical information in the early evaluation of this population.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698478","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":"Carrying stones.","authors":"Silvia Elli","doi":"10.1007/s11739-026-04337-7","DOIUrl":"https://doi.org/10.1007/s11739-026-04337-7","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672958","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}