Internal and Emergency Medicine最新文献

{"title":"Unsupervised machine learning with Cluster Analysis in patients with rheumatoid arthritis: insights in CV risk phenotypes from a multicentre Italian cohort.","authors":"Vincenzo Venerito, Elena Bartoloni, Gian Luca Erre, Matteo Piga, Garifallia Sakellariou, Ombretta Viapiana, Andreina Manfredi, Elisa Gremese, Fabiola Atzeni, Francesca Romana Spinelli, Fabio Cacciapaglia","doi":"10.1007/s11739-026-04478-9","DOIUrl":"https://doi.org/10.1007/s11739-026-04478-9","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) patients face increased cardiovascular (CV) risk, yet existing 10-year estimation tools often underperform. This study evaluated whether unsupervised machine learning (uML) clustering can identify distinct RA patient phenotypes with varying major cardiovascular events (MACE) potentially improving risk stratification. A cross-sectional, multi-center cohort of RA patients meeting the 2010 ACR/EULAR classification criteria and without prior CV events was enrolled in January 2019 and followed-up for MACE incidence over 5 years. Clinical and demographic data, including traditional CV risk factors and SCORE2 estimates, were collected. Factor Analysis of Mixed Data (FAMD), a generalization of principal component analysis for mixed data types, was applied in Python (ver.3.9) using Prince (ver.0.7.1). Missing data observations were excluded. Bootstrapped eigenvalue distribution determined the number of FAMD components for clustering, followed by Hierarchical Clustering on Principal Components using Ward's criterion and Euclidean distance. An XGBoost model assessed feature importance, while ANOVA and Chi-square tests evaluated cluster differences. Among 951 RA patients (mean age 61.8 ± 10.5 years; 81.1% female; median disease duration 120 months), 9 MACE occurred (incidence: 1.89/1000 patient-years). Four clusters emerged: Cluster 1 (high HAQ, steroid use, high cholesterol), Cluster 2 (low disease activity, BMI, diabetes, hypertension, SCORE2), Cluster 3 (predominantly male, < 10-year disease duration, csDMARDs; no MACE cases), and Cluster 4 (longer disease duration, hypertension, high triglycerides, lipid-lowering agents, TNFi; highest MACE incidence).uML clustering identified distinct RA phenotypes, complementing SCORE2 for improved CV risk stratification and aiding in recognizing patients at elevated MACE risk.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A splanchnic venous thrombosis revealing Biermer's disease: a case report.","authors":"Abdelghani Bachir Cherif, Salam Bennouar, Sara Benzaamia, Yousra Djebbar, Elayadi Nazli","doi":"10.1007/s11739-026-04347-5","DOIUrl":"10.1007/s11739-026-04347-5","url":null,"abstract":"<p><p>Biermer's disease, or pernicious anemia, is an autoimmune condition marked by vitamin B12 deficiency due to intrinsic factor antibodies targeting gastric parietal cells. The relationship between Biermer's disease and increased thrombotic risk, while uncommon, represents a critical clinical concern necessitating heightened diagnostic awareness for patients presenting with unexplained thrombotic symptoms. This report details the case of a 57-year-old Mediterranean male, with a prior diagnosis of Graves' disease, who developed splanchnic venous thrombosis. An extensive etiological investigation revealed mild hyperhomocysteinemia, associated with an undiagnosed Biermer's disease. Our case underscores a critical association between Biermer's disease, hyperhomocysteinemia, and venous thrombosis, emphasizing the imperative for further research elucidating their interconnected pathogenesis.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2201-2205"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is your next step? A case of a composite dyslipidemia with atherosclerotic trajectory: bridging primary care to internal medicine setting.","authors":"Marco Prastaro, Maria Maddalena Grattagliano, Oleg Kats, Antinisca Pignatiello, Piero Portincasa","doi":"10.1007/s11739-026-04376-0","DOIUrl":"10.1007/s11739-026-04376-0","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2207-2209"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Euglycemic ketoacidosis in a nondiabetic patient with Duchenne muscular dystrophy on dapagliflozin: comment.","authors":"Claudia Stöllberger, Josef Finsterer","doi":"10.1007/s11739-026-04328-8","DOIUrl":"10.1007/s11739-026-04328-8","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2355-2356"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated POCUS-driven hemodynamic management in septic shock: a clinical note.","authors":"Diamante Quarantelli, Claudio Giumelli, Paolo Montanari, Aderville Cabassi","doi":"10.1007/s11739-026-04465-0","DOIUrl":"10.1007/s11739-026-04465-0","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2331-2333"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of fascial block on opioid consumption in patients with multiple rib fractures: a retrospective observational study.","authors":"Sossio Serra, Domenico Pietro Santonastaso, Giuseppe Romano, Alessandro Riccardi, Francesca Ortu, Vanni Agnoletti, Mario Guarino, Claudia Sara Cimmino, Michele Domenico Spampinato, Michela Cascio, Raffella Francesconi, Fabio De Iaco","doi":"10.1007/s11739-025-04144-6","DOIUrl":"10.1007/s11739-025-04144-6","url":null,"abstract":"<p><p>Pain is a common feature in multiple rib fractures. Opioids are the mainstay of analgesic therapy due to their high efficacy, however, can lead to a reduction in respiratory rate and tidal volume, sedation and respiratory failure. Fascial blocks can provide safe, adequate analgesia with only local effects. This study aims to investigate the effect of fascial block on the reduction of total opioid consumption. A retrospective observational study, conducted in the emergency medicine unit (EMU), including all adult, opioid-naïve patients admitted between January 2022 and August 2024 with post-traumatic blunt chest trauma. 103 patients, 26 (27.9%) women, with a median age of 62 years (IQR 56-76), a median Thoracic Trauma Severity Score (TTSS) of 8 (IQR 7-9), a median pain score of 8 on the 0-10 Numeric ranking scale, and 66 patients (60.2%) underwent fascial block. Median total opioid consumption was 92 morphine milligram equivalents (IQR 61.5-140), significantly lower in patients undergoing fascial block (71 (IQR 60-101) vs. 150 (110-210), p < 0.001), despite higher pain on admission (8 (IQR 7-9) vs. 6 (IQR 5-7), p < 0.01), with better pain control and no differences in total length of stay, TTSS or number of rib fractures. This study shows that fascial blocks in patients admitted to the EMU for post-traumatic pain due to multiple rib fractures are associated with a significant reduction in overall opioid consumption and no specific complication, supporting the use of a multimodal approach for better pain control.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2241-2249"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novelty to necessity: large language models in clinical practice-a call to action for physicians.","authors":"Vittorio Beltrani, Olivier Giannini, Omar F AbouEzzeddine, Martin R Gruebler, Federico Mastroleo, Gregorio Tersalvi","doi":"10.1007/s11739-026-04393-z","DOIUrl":"10.1007/s11739-026-04393-z","url":null,"abstract":"<p><p>Large language models (LLMs) represent a rapidly advancing subset of artificial intelligence with significant potential to augment clinical practice. These tools can assist in literature synthesis, documentation, clinical reasoning, and patient communication. Despite demonstrated capabilities, adoption in healthcare remains limited due to barriers such as limited AI literacy, trust concerns, integration challenges, and generational disparities in digital proficiency. This review critically examines the role of LLMs as cognitive adjuncts in medicine, emphasizing the need for calibrated trust, human oversight, structured implementation strategies, and robust regulatory governance. Evidence suggests that stepwise integration of LLMs, beginning with low-risk tasks, may enhance physician efficiency, reduce cognitive burden, and may support high-quality care. Key limitations, including hallucinations, data currency, environmental impact, and data security, have to be addressed, alongside the need for continuous model refinement. Rigorous clinical trials are needed to establish the efficacy of LLMs. This includes the recognition that LLMs trained on vast web data may contain personal health information, creating a significant privacy risk. Responsible adoption of LLMs is essential to meet the demands of modern medicine while preserving clinical accountability and patient-centered care.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1991-2000"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of glucagon-like peptide-1 receptor agonists and dual glucagon-like peptide-1 receptor agonists/glucose-dependent insulinotropic polypeptide on liver stiffness and steatosis evaluated through Fibroscan^®: a systematic review and meta-analysis.","authors":"Antonella Berardicurti, Settimio D'Andrea, Francesco Cipollone, Onorina Berardicurti, Cosima Schiavone, Andrea Boccatonda","doi":"10.1007/s11739-026-04384-0","DOIUrl":"10.1007/s11739-026-04384-0","url":null,"abstract":"<p><p>Metabolically associated fatty liver disease (MASLD) is highly prevalent among individuals with obesity and type 2 diabetes. Glucagon-like peptide-1 receptor agonists (GLP1-RA) and glucagon-like peptide-1 receptor agonists/glucose-dependent insulinotropic polypeptide (GLP1-RA/GIP) dual agonists have demonstrated favorable effects on liver health. Liver steatosis and stiffness can be noninvasively assessed using transient elastography with Fibroscan^®. However, evidence regarding the impact of incretin therapy on these elastographic outcomes remains inconsistent across available studies. Indeed, we performed a systematic review and meta-analysis of randomized-controlled trials and case-control studies, which aimed to investigate the effect of GLP1-RA or GLP1-RA/GIP on liver stiffness and steatosis evaluated with Fibroscan^® (PROSPERO registration number CRD420251162316). We searched PubMed, Web of Science, and Scopus for English-language studies till March 2025. Methodological quality of the studies was assessed by the Newcastle-Ottawa Scale or Jadad score. In the presence of heterogeneity, standardized (Std) mean differences with 95% confidence intervals (CIs) were combined using a random effect model. Funnel plot and trim-and-fill analysis were used to assess publication bias. Five studies were included in the analysis, accounting for 9 trials. A total of 554 patients and 270 controls were enrolled. The analysis revealed an improvement for both liver stiffness [std. mean difference = - 0.3, 95%CI - 0.5 to - 0.1, p = 0.02] and liver steatosis [std. mean difference = - 0.4, 95%CI - 0.7 to - 0.1, p = 0.03] at the end of the trial. Our findings showed that treatment with GLP1-RA and GLP1-RA/GIP in people with MASLD improves liver stiffness and steatosis evaluated through Fibroscan^®.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1979-1990"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948484","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":"Global and regional burden of cardiovascular diseases due to low physical activity from 1990 to 2021 and projections to 2045: a joinpoint regression and age-period-cohort analysis based on GBD 2021.","authors":"Tenglong Hu, Yunping Li, Yanyan Du, Yangyu Zhao, Lei Chen, Na Sun, Qiang Sun, Wenyan Liang, Rongjing Ding, Xiqing Wei, Zhiqiang Zhang","doi":"10.1007/s11739-026-04412-z","DOIUrl":"10.1007/s11739-026-04412-z","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) continues to represent a major public health concern, and low physical activity is identified as a key contributing risk factor. This study estimated the global burden and trends of CVD attributable to low physical activity over the past 32 years and projected them to 2045. This study analyzed trends in the burden of CVD attributable to low physical activity using the 2021 Global Burden of Disease data. The age-period-cohort model was employed to investigate the impacts of age, time periods, and birth cohorts on the CVD burden, while temporal trends were analyzed using joinpoint regression analysis. The Bayesian age-period-cohort model (BAPC) is used to predict the burden of CVD attributable to low physical activity from 2022 to 2045. Despite an increase in the global number of CVD deaths and DALYs attributable to low physical activity, both the age-standardized mortality rate (ASMR) and the age-standardized DALY rate (ASDR) have significantly declined. The projections for 2045 and the age-period-cohort model indicate substantial progress in reducing CVD mortality and DALYs, but the total number of CVD deaths and DALYs continues to increase. The study results suggest that although the global burden of CVD attributable to low physical activity has increased in absolute numbers, the age-standardized rates show a downward trend. It is crucial to develop targeted preventive strategies aimed at reducing the burden of CVD attributable to low physical activity, particularly among the elderly and in regions with limited healthcare resources.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2175-2191"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258012","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":"Abstract-to-publication ratio and predictors for publication success for papers presented at an Italian Internal Medicine Meeting: a cross-sectional study.","authors":"Vincenzo G Menditto, Elisabetta Fausti, Giacomo Menditto, Beatrice Gasperini","doi":"10.1007/s11739-026-04315-z","DOIUrl":"10.1007/s11739-026-04315-z","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2353-2354"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485776","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}