Internal and Emergency Medicine最新文献

{"title":"Real‑world clinical evaluation of the Inflammatix TriVerity test for sepsis at the emergency department-an Acutelines study: comment.","authors":"Lan Yang, Xiang Lin","doi":"10.1007/s11739-026-04521-9","DOIUrl":"https://doi.org/10.1007/s11739-026-04521-9","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919514","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":"Fasting before elective abdominal ultrasound: a systematic review and meta-analysis.","authors":"Trixi Braasch, Ildiko Hoffmann, Andreas Deckert, Olaf Horstick, Britta Siegmund","doi":"10.1007/s11739-026-04511-x","DOIUrl":"https://doi.org/10.1007/s11739-026-04511-x","url":null,"abstract":"<p><p>Fasting before elective abdominal ultrasound is widely recommended to improve image quality or visualization of abdominal structures although supporting evidence is limited. We examined whether fasting is associated with improved diagnostic or image quality-related outcomes in adult abdominal ultrasound. We conducted a systematic review and meta-analysis (PROSPERO CRD42024568514) of studies comparing fasting and non-fasting conditions in adults undergoing elective abdominal ultrasound (search date July 18, 2025; 5 databases). Study quality and risk of bias were assessed, and randomized trials were pooled using random effects models. Real-world preparation recommendations were evaluated across international ultrasound society guidelines and patient-facing sources. 14 studies (9 randomized trials, 5 observational studies; 2,208 participants) met the inclusion criteria. Five randomized trials were eligible for meta-analysis; three were included in the primary analysis (n = 378). Two trials contributed organ-specific outcomes to sensitivity analyses. Fasting did not improve overall diagnostic sufficiency, defined as adequate visualization to answer the clinical question without repeat imaging (OR 0.97, 95% CI 0.51-1.86, p = 0.92; I² = 0%). Significant effects were limited to gallbladder visibility and detectability of the common bile duct, with no consistent benefit otherwise. Risk of bias was moderate and overall certainty of evidence was low. Real-world fasting instructions were highly variable and rarely evidence-based. Fasting before elective abdominal ultrasound does not improve diagnostic sufficiency. Observed benefits were limited to the biliary tract. Given the low certainty of evidence and limited observed benefits beyond the biliary tract, strict and prolonged fasting recommendations should be reconsidered.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919551","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":"Acute cholestatic jaundice and coagulopathy in a middle-aged woman.","authors":"Cátia Barra, António Mateus-Pinheiro, Andreia Henriques, Augusta Cipriano, Isabel Fonseca","doi":"10.1007/s11739-026-04513-9","DOIUrl":"https://doi.org/10.1007/s11739-026-04513-9","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900225","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":"Hypoxemic respiratory failure in patients with acute heart failure.","authors":"Josep Masip, Pere Llorens, Víctor Gil, Pedro Lopez-Ayala, Begoña Espinosa, Judith Gorlicki, Aitor Alquézar, Javier Jacob, Juan Antonio Andueza, Javier Millán, Carlos Bibiano, Julio Núñez, Eva Domingo, Enrique Martín, Carolina Sánchez, Sandra Cuerpo, Yonathan Freund, Zubaid Rafique, Christian Mueller, William Frank Peacock, Òscar Miró","doi":"10.1007/s11739-026-04508-6","DOIUrl":"https://doi.org/10.1007/s11739-026-04508-6","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of hypoxemia and the indications for oxygen therapy in patients with acute heart failure (AHF) are not well known.</p><p><strong>Methods: </strong>A large nationwide registry of unselected AHF patients attended in the emergency department (ED) was analysed. Oxygen saturation by pulse-oximetry (SpO₂) was measured on ED arrival, and the ratio SpO₂/F_IO₂ was calculated to adjust for the impact of pre-hospital oxygen therapy, stratifying patients into three groups: normal ratio (≥ 452; corresponding approximately to a SpO₂>94%, on room air), mild decrease of the ratio (429-451; SpO₂~90-94%) and hypoxemia (≤ 428; SpO₂~<90%). Unadjusted and adjusted 30-day all-cause mortality was analyzed by category and restricted cubic spline (RCS).</p><p><strong>Results and discussion: </strong>Of 18,904 AHF patients, 6949 (36.7%) had normal SpO₂/F_IO₂, 5438 (28.8%) showed mild decrease of the ratio, and 6517 (34.5%) were hypoxemic. Hypoxemia was documented in 40% of hospitalized patients and was observed in all phenotypes, ranging from 18.6% in acute decompensated heart failure, to 100% in acute pulmonary oedema. The severity of most physiological parameters, the level of biomarkers, the rate of comorbidities and the 30-day all-cause mortality risk were inversely related to SpO₂/F_IO₂. Mortality risk progressively increased for SpO₂/F_IO₂<452 but became nearly flat when it was<350 suggesting that the prognosis did not depend only on the severity of respiratory failure.</p><p><strong>Conclusions: </strong>Impaired oxygenation was observed in nearly two thirds of patients with AHF attended in ED. Hypoxemia occurred in 40% of those hospitalized, affecting all phenotypes and was associated with more severity and worse prognosis. This should be considered when addressing treatment recommendations for these patients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906202","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 safety analysis of tenecteplase vs. alteplase in very elderly patients with acute ischemic stroke: a systematic review and meta-analysis of randomized trials.","authors":"Keying Zhang, Qi Wang, Tao Gong, Yuhui Chen","doi":"10.1007/s11739-026-04517-5","DOIUrl":"10.1007/s11739-026-04517-5","url":null,"abstract":"<p><p>Tenecteplase (TNK) is a modified variant of alteplase (TPA) that offers advantages such as a long plasma half-life and high fibrin specificity. Previous studies have demonstrated the noninferiority of TNK to TPA in patients with acute ischemic stroke (AIS). Although very elderly patients (aged ≥ 80 years) represent a significant proportion of AIS cases, research on the safety and efficacy of TNK in this population remains limited. Therefore, this study aimed to evaluate the comparative efficacy and safety of TNK versus TPA in treating AIS in very elderly patients. We conducted a meta-analysis of randomized controlled trials (RCTs) from Embase, PubMed, and the Cochrane Library up to May 20th, 2026. The outcomes included modified Rankin Scale (mRS) scores of 0-1 and 0-2 at 90 days, symptomatic intracranial hemorrhage (SICH), all-cause mortality, and parenchymal hematoma. We also performed subgroup analysis to assess the effects of patient race. We utilized mainly Review Manager 5.4 software to conduct the data synthesis and statistical analysis. Five RCTs (EXTEND-IA TNK, AcT, ATTEST-2, TRACE-2, and ORIGINAL) involving 1307 very elderly patients were included. Pooled analysis showed that TNK was associated with higher odds of excellent and good functional outcomes at 90 days compared with TPA (excellent: odds ratio (OR) 1.85, 95% confidence interval (CI) 1.06-3.23, p = 0.03, I² = 75%; good: OR 1.35, 95% CI: 1.06-1.71, p = 0.01, I² = 3%). Leave-one-out sensitivity analysis showed that the association between TNK and excellent functional outcomes was no longer statistically significant after exclusion of the ORIGINAL trial (OR 1.38, 95% CI 0.91-2.08, p = 0.13, I² = 52%). No statistically significant differences were observed between TNK and TPA in SICH (OR 1.00, 95% CI 0.54-1.89, I² = 0%), 90-day mortality (OR 0.84, 95% CI 0.63-1.11, I² = 0%), or parenchymal hematoma (OR 0.73, 95% CI 0.30-1.74, I² = 5%). In this pooled analysis of noninferiority-designed RCTs, TNK was associated with a trend toward improved functional outcomes compared with TPA in very elderly patients with AIS. However, the statistical significance of the excellent functional outcome was dependent on the inclusion of the ORIGINAL trial, and the association was no longer significant after its exclusion. This finding, combined with the high heterogeneity and small sample sizes, and the high risk of bias related to deviations from intended interventions in most included trials, suggests that the results should be regarded as hypothesis-generating. As all included trials were designed as noninferiority studies, adequately powered superiority trials are warranted to confirm the potential benefit of TNK over TPA in this population.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906133","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 dehumanization of the last hours: reflections of a night-duty physician.","authors":"Annarita Botta","doi":"10.1007/s11739-026-04522-8","DOIUrl":"https://doi.org/10.1007/s11739-026-04522-8","url":null,"abstract":"","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":"148891554","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":"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}