Internal and Emergency Medicine最新文献

{"title":"Residual congestion and urinary sodium and chloride trajectories in acute heart failure.","authors":"Amelia Campos-Sáenz de Santamaría, Laura-Karla Esterellas-Sánchez, Marc Gómez-Godos, Silvia Crespo-Aznarez, Marta Sánchez-Marteles, Vanesa Garcés-Horna, Ignacio Giménez-López, Joan Carles Trullas, Jorge Rubio-Gracia","doi":"10.1007/s11739-026-04543-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04543-3","url":null,"abstract":"<p><p>Residual congestion remains frequent after initial treatment for acute heart failure (AHF), and its presence may not be adequately identified using individual clinical or biochemical markers. We investigated residual congestion using a multimodal approach and examined its relationship with changes in urinary sodium and chloride during the first 72 h of hospitalization. We prospectively included consecutive patients hospitalized for AHF who underwent congestion assessment at admission and 72 h. Clinical evaluation, NT-proBNP, and venous Doppler ultrasound (VExUS) were integrated to assess congestion. Residual multimodal congestion was defined by the presence of at least two of three criteria: VExUS score ≥ 1, < 30% reduction in NT-proBNP, and clinical congestion score ≥ 3. Urinary sodium and chloride were measured at admission and 72 h, and their changes over time were evaluated using linear mixed-effects models. Baseline estimated glomerular filtration rate (eGFR), worsening renal function, and urinary albumin-to-creatinine ratio were additionally characterized. Among 146 patients, 67 (45.9%) had residual multimodal congestion at 72 h. Urinary sodium and chloride concentrations were lower in patients with residual congestion. Both electrolytes decreased during the first 72 h (p < 0.001 for both), but their changes differed according to residual congestion status, with significant time-by-group interactions for sodium (p = 0.013) and chloride (p = 0.001). Patients with residual congestion also showed a trend toward poorer 180-day event-free survival, although this difference did not reach statistical significance (log-rank p = 0.078). Patients with residual congestion showed different early patterns of urinary sodium and chloride during treatment for AHF. Serial measurement of these electrolytes may complement clinical, biochemical, and venous ultrasound assessment when evaluating the response to decongestive therapy. These findings support their potential role in characterizing different decongestive profiles, although their clinical and prognostic value requires further evaluation.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109309","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":"miR-454-3p alleviates LPS-induced cardiomyocyte damage by negatively regulating STAT3 in sepsis-induced cardiomyopathy.","authors":"Zimo Sha, Tianzhichao Hou, Taojie Zhou, Yangyang Bao, Yue Wei, Tianyou Ling, Liqun Wu","doi":"10.1007/s11739-026-04532-6","DOIUrl":"https://doi.org/10.1007/s11739-026-04532-6","url":null,"abstract":"<p><p>Sepsis-induced cardiomyopathy (SICM) contributes greatly to high mortality in critically ill patients. Accumulating evidence indicates that miRNAs play key roles in sepsis-related organ injury. This work investigated the function and molecular mechanism of miR-454-3p in SICM, along with its potential clinical utility. A total of 100 healthy controls and 210 sepsis patients were enrolled. Sepsis patients were categorized into non-cardiomyopathy group (non-CM, n=105) and SICM group (n=105). Receiver operating characteristic (ROC) curve analysis, multivariate logistic regression, and Cox regression were performed to assess the clinical value of miR-454-3p. In vitro functional experiments were conducted using LPS-stimulated AC16 cardiomyocytes. The dual-luciferase reporter assay verified the targeting relationship between miR-454-3p and STAT3. miR-454-3p expression decreased progressively from healthy controls to non-CM patients and further to SICM patients. miR-454-3p demonstrated good diagnostic performance for SICM. Multivariate analysis identified miR-454-3p as both an independent protective factor against SICM and an independent predictor of favorable prognosis. Cellular experiments revealed that miR-454-3p directly binds to the 3'UTR of STAT3 and suppresses STAT3 expression. Functional assays indicated that miR-454-3p attenuates LPS-induced cardiomyocyte apoptosis, inflammation, and oxidative stress, whereas STAT3 overexpression reverses these protective phenotypes. Furthermore, western blot analysis showed that miR-454-3p inhibits activation of the JAK2/STAT3/NF-κB inflammatory cascade. In vitro assays suggest that miR-454-3p alleviates LPS-triggered cardiomyocyte damage by negatively regulating STAT3 and suppressing the JAK2/STAT3/NF-κB inflammatory cascade. Our single-center observational data indicate that circulating miR-454-3p correlates independently with SICM incidence and 28-day all-cause mortality, implying its potential value as a candidate diagnostic and prognostic biomarker for SICM. Nevertheless, correlational findings from this cross-sectional cohort cannot confirm causal relationships, and large-scale multicenter prospective cohorts are needed for external validation to verify its clinical utility.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109255","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":"Angiotensin receptor-neprilysin inhibitor versus angiotensin-converting enzyme inhibitor for osteoporosis risk in patients with heart failure.","authors":"Wei-Syun Hu, Yu-Chieh Wang","doi":"10.1007/s11739-026-04541-5","DOIUrl":"https://doi.org/10.1007/s11739-026-04541-5","url":null,"abstract":"<p><p>This research presents a real-world study investigating the association between angiotensin receptor-neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitors (ACEI) use and the risk of osteoporosis in patients with heart failure (HF). During the study period from 2017 to 2022, HF patients were classified as users of ACEI or ARNI based on prescription records. After 1:1 propensity score matching, a total of 12,808 HF patients were included, with 6,404 patients in each treatment group (ACEIs vs. ARNIs). The unadjusted model included only treatment exposure, whereas the adjusted model accounted for potential confounders. In the risk factor analysis for osteoporosis among patients with HF, use of ARNI was associated with a significantly lower risk of osteoporosis compared with ACEI in the multivariable-adjusted model (adjusted HR [aHR] 0.6, 95% CI 0.4-0.88, p = 0.0092). Among HF patients, ARNI use was associated with a lower risk of osteoporosis than ACEI use.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109278","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":"Two-dimensional shear wave elastography-based assessment of liver stiffness in critically ill patients with septic shock: a prospective observational study.","authors":"Khalid Zafar, Zafar Neyaz, Sai Saran, Samir Mohindra, Prabhaker Mishra, Afzal Azim, Banani Poddar, Mohan Gurjar","doi":"10.1007/s11739-026-04536-2","DOIUrl":"https://doi.org/10.1007/s11739-026-04536-2","url":null,"abstract":"<p><p>The acute effects of resuscitation on the liver during septic shock, as assessed through liver stiffness, are not well understood. The objective of this pilot study was to evaluate liver stiffness in patients with septic shock using two-dimensional shear wave elastography (2D-SWE). This prospective study was conducted at a 30-bed ICU of a university hospital. Patients with septic shock, who had apparently normal liver status before current illness, requiring vasopressors for ≥ 24 h were considered within 7 days after the onset of shock. Patients with pre-existing liver diseases, congestive heart failure, intra-abdominal hypertension, recent history of abdominal trauma/surgery, body mass index ≥ 35 kg/m², and pregnancy were excluded. Liver stiffness was measured by 2D-SWE scan, which was repeated after at least 4 weeks of recovery from shock. Fifty-two patients aged 44 (34-63) years in septic shock with median SOFA score 9 (IQR 6-11) were included. The median liver stiffness after the onset of septic shock was 30 kPa (IQR 25.2-34.2), a significantly higher than normal value (< 7 kPa). This stiffness was significantly associated with vasoactive dose index (VDI) [linear regression coefficient (β): 23.02; 95%CI 16.60-29.69; p = 0.001]. The limited follow-up measurements (in 18 survivors) revealed a marked reduction in liver stiffness values from 29 kPa (IQR 26-32) to 6 kPa (IQR 5.4-6.4). Assessment of liver through 2D-SWE, after the onset of septic shock in apparently normal liver status pre-illness, revealed increased stiffness. However, it reverted to normal once clinical condition improved. Clinical Trials Registry - India: CTRI/2023/06/053891.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109250","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":"Methods for teaching postgraduate point-of-care ultrasonography: a systematic review.","authors":"Marine Baumberger, Claudio Schneider, André Juillerat, Pierre Ritz, Radhika Sood, Stijn Bex, Christophe Marti, Jean Luc Reny, Olivier Grosgurin, Antonio Leidi","doi":"10.1007/s11739-026-04535-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04535-3","url":null,"abstract":"<p><p>Point-of-care ultrasonography (POCUS) is increasingly used across multiple medical specialties, yet the impact of different teaching methods on learning outcomes remains unclear. Conduct a systematic review of randomized controlled trials (RCTs) comparing different methods of POCUS training and synthesize the available data. We searched MEDLINE, EMBASE, Cochrane, ERIC, and PsycINFO without language or date restrictions. Eligible studies were RCTs evaluating POCUS teaching methods for physicians. Studies focusing on pre-graduate learners, transesophageal or transvaginal ultrasound and procedural guidance were excluded. Records were screened and data were extracted by independent reviewers. Methodological quality assessment was performed using the Modified Medical Education Research Study Quality Instrument. The study protocol was prospectively registered in the international database of PROSPERO (CRD42024512650). Thirty-seven RCTs including 1,571 participants were identified. Interventions were grouped as simulation-based training (ten studies), web-based or video-assisted learning (ten studies), variations in training intensity or structure (eight studies), tele-mentoring (four studies), and other methods (five studies), mostly in comparison with traditional classroom teaching. Across most trials, interventions produced theoretical and practical skills without significant difference to traditional classroom models. Superiority was mainly observed when the intervention arm received greater training intensity or longitudinal supervision. Most studies used heterogeneous, non-standardizable assessments, precluding meta-analysis. For non-procedural postgraduate POCUS, several sustainable educational alternatives exist and may allow for similar competence when compared to traditional teaching. Training intensity, supervision, and longitudinal exposure may be more important determinants of learning outcomes than the teaching modality itself. Cognitively enriched formats may provide additional benefits. Further research is needed to define the optimal structure of POCUS curricula. Only one study assessed patient-centered outcomes, limiting conclusions regarding the clinical impact of educational interventions.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080524","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":"Predictive ability of two frailty screening tools for older patients in an emergency department: a comparative study.","authors":"Merete Gregersen, Troels Kjærskov Hansen, Ilona Davodian, Mathumila Thavapperai, Asmus Laue Tiufkær, Sofie Bach Clausen, Lone Winther Lietzen","doi":"10.1007/s11739-026-04538-0","DOIUrl":"https://doi.org/10.1007/s11739-026-04538-0","url":null,"abstract":"<p><p>Frailty identification is crucial for guiding individualized treatment in emergency geriatric care. The aims were to prospectively evaluate frailty status in all patients aged 65 and older presenting with acute illness in the emergency department (ED), and to compare the predictive performance of bedside-assessed Brief Multidimensional Prognostic Index (B-MPI), with healthcare professional-assessed Clinical Frailty Scale (CFS) for unplanned readmissions and 30- and 90-day mortality. This prospective observational cohort study evaluated frailty status in 402 patients aged 65 years or older admitted to the ED at Aarhus University Hospital, Denmark, between April 2023 and January 2025 and included through convenience sampling. Frailty was assessed using two validated tools: the CFS, administered by physicians or geriatric healthcare staff, and the B-MPI, administered bedside incorporating patient interviews or caregiver input, and electronic medical record data. Data showed that 40% of the older patients were classified as frail by the CFS, while 50% were moderately or severely frail according to the B-MPI. Both tools predicted 30-day and 90-day mortality with no difference in accuracy for predicting mortality. Neither tool effectively predicted unplanned hospital readmissions. Mortality rates in the cohort were 5.7% at 30 days and 12.9% at 90 days post-admission. The findings suggest that both tools are valuable for identifying frailty and predicting mortality in older acutely ill patients. However, the absence of a statistically significant difference between the tools should not be interpreted as evidence of equivalence or comparable performance.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074500","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 data-driven digital twin of emergency department flow to quantify congestion dynamics and test operational resilience.","authors":"Alexandre Vallée","doi":"10.1007/s11739-026-04540-6","DOIUrl":"https://doi.org/10.1007/s11739-026-04540-6","url":null,"abstract":"<p><p>Emergency department (ED) overcrowding is associated with delayed care, adverse outcomes, and reduced system efficiency. Conventional models often fail to capture the nonlinear and state-dependent dynamics of real-world ED operations. Digital twins, computational replicas that evolve with operational data, offer a promising framework for evaluating system resilience and testing organizational policies. To develop and validate a data-driven digital twin of ED upstream flow capable of reproducing congestion dynamics and quantifying the impact of operational interventions on performance and extreme delays. We used routinely collected data from 41,818 ED visits to build a closed-loop digital twin of patient flow. Process times were modeled using regularized regression and stochastic simulation with dynamic updates of system state. The model was calibrated on January-September data and evaluated out-of-sample on October-November visits. Counterfactual operational scenarios were then simulated. In the test period (7596 visits), median ED length of stay was 266 min, with 20.1% exceeding 8 h. The digital twin reproduced observed performance (simulated median 276 min). A 20% increase in arrivals produced nonlinear deterioration, with more than 90% of visits exceeding 8 h. Reducing post-triage waiting time produced the largest isolated improvement, lowering prolonged stays >8 h to 19.3%, while the combined intervention reduced them to 17.9%. A closed-loop digital twin can reproduce ED congestion dynamics and identify high-impact operational levers to support resilience planning and decision-making.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069444","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":"Oral semaglutide vs DPP-4 inhibitors in reducing risk of cognitive impairment in elderly patients with HFpEF and obesity.","authors":"Fatima Ayyaz, Haris Khan, Ifza Zia","doi":"10.1007/s11739-026-04539-z","DOIUrl":"https://doi.org/10.1007/s11739-026-04539-z","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060699","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 2024 Lebanon conflict: a multidimensional assessment of syndemic impacts on public health and sustainable development goals.","authors":"Mohamad Khalil, Zeinab Bannout, Nour Jaber, Dima Obeid, Zainab Mhanna, Ali Madani, Diana Srour, Ahmad Arzouni, Hala Abdallah, Laura Mahdi, Hassan Karaki, Layal Safa, Ali Mchiek, Hassan Lakiss, Agostino Di Ciaula, Piero Portincasa","doi":"10.1007/s11739-026-04534-4","DOIUrl":"https://doi.org/10.1007/s11739-026-04534-4","url":null,"abstract":"<p><p>Lebanon entered the 2024 armed conflict with health, environmental, and social systems already weakened by successive crises, including the COVID-19 pandemic, prolonged economic collapse, and the 2020 Beirut Port explosion. This narrative review aimed to synthesize evidence on the documented and anticipated effects of the conflict on public health, healthcare services, the environment, food security, education, and progress toward the Sustainable Development Goals (SDGs). Evidence was drawn from peer-reviewed studies and reports issued by governmental institutions and international organizations. Documented damage to hospitals and primary healthcare facilities, together with disruptions to medical supply chains, affected routine and emergency care and complicated the management of chronic diseases. Population displacement, overcrowding, and interruptions to essential services also increased the risk of infectious disease transmission and created conditions that may facilitate the spread and emergence of antimicrobial resistance, particularly in displaced and otherwise vulnerable populations. Concurrently, explosive weapons, fires, and infrastructure damage affected air, water, soil, agricultural land, and ecosystems. These environmental and agricultural impacts created plausible pathways linking conflict-related damage to food security, livelihoods, and long-term population health, although direct epidemiological evidence remains limited. Overall, the conflict generated interconnected pressures across health, environmental, and social systems and compounded pre-existing vulnerabilities. Coordinated recovery efforts should restore healthcare capacity, protect environmental and agricultural resources, strengthen surveillance, and support essential social services to reduce long-term harm and promote sustainable recovery.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060753","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":"Smoking cessation in emergency departments: a reality check.","authors":"D Campagna, F Cucuzza, C Russo, J A Putra, P Caponnetto, G R M La Rosa, U Prosperini, S Agrawal, R Polosa","doi":"10.1007/s11739-026-04528-2","DOIUrl":"https://doi.org/10.1007/s11739-026-04528-2","url":null,"abstract":"<p><p>Emergency Departments (EDs) see a high prevalence of people who smoke, many of whom present with acute smoking-related conditions (e.g., myocardial infarction, stroke, pneumonia, and asthma/COPD exacerbations). The immediacy of illness creates a strong \"teachable moment,\" increasing receptiveness to risk communication and behavior change. Evidence indicates that pairing brief counseling with point-of-care therapeutic support and structured follow-up improves abstinence, although effects vary with local infrastructure, product availability, and staffing models. Despite this promise, scale-up is often constrained by economic barriers, limited staffing and training, and weak integration of cessation workflows into routine ED practice. The aim of this article is to provide a reality check on ED-based smoking cessation by synthesizing evidence on effectiveness, feasibility, cost-effectiveness, and safety across health-system contexts, and by outlining pragmatic delivery models and research priorities. Embedding low-friction, clinically governed cessation bundles within EDs has the potential to convert acute presentations into durable quit attempts and reduce smoking-related harm at scale, though this population-level impact remains a hypothesis to be tested. Future work should prioritize pragmatic and implementation trials with biochemically verified outcomes, integration metrics, equity impacts, and cost-utility analyses to guide sustainable adoption across diverse settings.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038482","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}