Internal and Emergency Medicine最新文献

{"title":"Associations between serum levels of ferroptosis-related molecules and outcomes in stable COPD: an exploratory prospective observational study.","authors":"Cristina Ghadban, Mayte García-Unzueta, Juan Agüero, Paula Martín-Audera, Bernardo Alio Lavín, Armando Raúl Guerra, Ana Berja, Nieves Aranda, Anastasia Guzun, Ana Isabel Insua, Carlos Antonio Amado","doi":"10.1007/s11739-025-04016-z","DOIUrl":"10.1007/s11739-025-04016-z","url":null,"abstract":"<p><p>Ferroptosis is an iron-dependent form of cell death that contributes to the pathophysiology of chronic obstructive pulmonary disease (COPD). Ferroptosis-associated factors, including acyl-CoA synthetase long-chain family 4 (ACSL4), soluble transferrin receptor 1 (sTfR1), glutathione peroxidase 4 (GPX4), and apoptosis-inducing factor 2, (AIFM2) mediate intracellular iron metabolism, oxidative stress, and lipid peroxidation. Despite their potential clinical relevance, no studies have measured serum levels of these factors with respect to the manifestations of COPD. The study enrolled 179 stable, non-anemic outpatients diagnosed with COPD and 57 age- and sex-matched smokers who did not carry this diagnosis. Clinical characteristics were assessed together with baseline serum levels of the four ferroptosis-associated factors. Moderate and severe exacerbations of COPD were monitored over the following 12 months. Soluble TfR1 levels were higher and GPX4 levels were lower among those in the COPD group compared to smokers without COPD (p = 0.004 and p = 0.002, respectively). The sTfR1/GPX4 ratio was also higher among those in the COPD group (p = 0.001). Multivariate analysis identified low serum GPX4 (OR 5.475; p = 0.001), and high sTfR1/GPX4 (OR 4.293; p < 0.001) as independent predictors of poor performance on the six-minute walk distance test. Additionally, high sTfR1 (HR 1.850; p = 0.004), low GPX4 (HR 2.301; p = 0.001), and high sTfR1/GPX4 (HR 2.223; p < 0.001) were associated with increased risk of moderate exacerbation. High sTfR1 (HR 2.970; p = 0.014), low GPX4 (HR 3.753; p = 0.012), and high sTfR1/GPX4 (HR 3.668; p = 0.009) were also independent predictors of severe exacerbation. Serum levels of ferroptosis-associated factors were significantly different in patients diagnosed with COPD compared to smokers who had not been diagnosed with this disorder. Elevated sTfR1, low levels of GPX4, and higher sTfR1/GPX4 were associated with poor clinical outcomes, including reduced exercise capacity and an increased risk of moderate and severe exacerbations. These findings highlight the potential of ferroptosis-associated factors, particularly the calculated sTfR1/GPX4, in predicting COPD progression and the risk of exacerbation in stable, non-anemic outpatients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1761-1773"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340081","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":"What do patients do during a familial Mediterranean fever attack? Their strategies and associated factors.","authors":"Özlem Kılıç, Seda Çolak, Emre Tekgöz, Mehmet Nur Kaya, Muhammet Çınar, Sedat Yılmaz","doi":"10.1007/s11739-025-04039-6","DOIUrl":"10.1007/s11739-025-04039-6","url":null,"abstract":"<p><p>Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease characterised by recurrent fever and serositis. Despite colchicine's proven efficacy, attacks may persist, necessitating the implementation of various mitigation strategies by patients.  To identify attack mitigation strategies and associated factors in FMF patients. A cross-sectional study at a tertiary rheumatology clinic included adults (≥ 18 years) meeting Tel-Hashomer criteria, on colchicine for ≥ 6 months, with ≥ 1 attack in the past six months. Patients were asked about their attack mitigation strategies, including colchicine dose increase, emergency department (ED) admission, resting, abdominal hot pack, dietary changes, on-demand anakinra, herbs, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroid use. Among 258 patients (98 men, 160 women; median age 35 years, disease duration 18 years), 93% used mitigation strategies. The most common first choice was ED admission (19.8%), followed by colchicine dose increase (18.2%), resting (14.3%), dietary changes (4.3%), NSAIDs (7%), paracetamol (6.6%), on-demand anakinra (6.2%), herbs (6.2%), and corticosteroids (5%). Normal C-reactive protein (CRP) levels, shorter last attack duration, lower international Severity Score for FMF (ISSF), non-working and non-M694V mutations were linked with colchicine dose increase (p < 0.05). M694V positivity, working, persistent CRP elevation, dominant serositis and musculoskeletal attacks, education level ≤ 8 years, longer last attack duration, higher ISSF, current colchicine resistance and non-adherence were linked with ED admission (p < 0.05). Most FMF patients used strategies to mitigate attacks, mainly ED admission and colchicine dose increase. These were influenced by genetic mutations, attack type, working status, education, and CRP levels.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1823-1833"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540079","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":"Demographic and regional trends in systemic and cardiovascular amyloidosis-related morality among older adults in the United States from 1999 to 2020: comment.","authors":"Chia-Ter Chao","doi":"10.1007/s11739-025-03949-9","DOIUrl":"10.1007/s11739-025-03949-9","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1983-1984"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004259","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":"Central retinal artery occlusion diagnosis and misdiagnosis in the emergency department.","authors":"Anniesha Bista Chhetri, Jacob Kammerman, Murtaza Akhter","doi":"10.1007/s11739-025-03990-8","DOIUrl":"10.1007/s11739-025-03990-8","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1967-1968"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247732","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":"Opioid-induced constipation in internal medicine: recognition and management pathways.","authors":"Piero Portincasa, Chiara Valentina Luglio, Silvia Sozzi, Claudia Conforti, Gianluca Bitonto, Michele Papavero, Gyorgy Baffy, Agostino Di Ciaula","doi":"10.1007/s11739-025-04091-2","DOIUrl":"10.1007/s11739-025-04091-2","url":null,"abstract":"<p><p>Opioid-induced constipation (OIC) remains one of the most frequent and distressing gastrointestinal side effects encountered by patients on chronic opioid therapy. Despite the high prevalence, OIC is frequently underdiagnosed and inadequately managed, with critical effects on the quality of life of patients. Aim of this review is to promote the awareness about OIC in the context of internal medicine. We examined the statement EnhanCing Healthcare Outcomes in Opioid-Induced Constipation (ECHO OIC) by European experts to streamline the diagnosis and management of OIC in clinical practice. Such guidelines have been further discussed by an Italian expert consensus to provide national customization and a multidisciplinary approach. The key finding is the implementation of a multi-step clinical pathway for prevention, diagnosis, treatment, and long-term management of OIC, taking into account the improvement of quality of life of patients. In conclusion, we urge to expand awareness about OIC. The seven-step diagnostic-therapeutic pathway approach formulated by ECHO OIC is a pragmatic and scalable model to improve OIC management with emphasis on education, early intervention, monitoring, tailored pharmacologic strategies, and coordinated referral when necessary.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1695-1704"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953062","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":"A quantitative needs assessment for a tele-ultrasound consult program in a tertiary care Emergency Department.","authors":"Onyinyechi F Eke, Kelechi Umoga, Christina Morone, Hamid Shokoohi, Andrew Liteplo, Jessica Haberer","doi":"10.1007/s11739-024-03809-y","DOIUrl":"10.1007/s11739-024-03809-y","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) has been shown to be beneficial in facilitating patient care, but its adoption is variable among emergency medicine (EM) clinicians. We identified the patterns of POCUS use and gaps in POCUS integration in a tertiary care emergency department (ED). These data provide a user-centered platform for subsequent development of a tele-ultrasound (tele-US) consultation program. We developed a 25-item needs assessment survey and used a 5-point Likert scale to assess current patterns of POCUS use and potential needs for POCUS among EM clinicians. Data were analyzed descriptively, and a chi-square analysis was used to assess for differences in POCUS use and comfort levels among clinicians. Overall, 48% (91/190) of eligible providers responded to the survey. Clinician responders included 38% (35/91) attendings (including fellows), 29% (26/91) residents, and 33% (30/91) advance practice providers (APPs). In assessing needs, 70% (58/83) of clinicians noted they would use POCUS more if they had more training. 76% (63/83) of clinicians felt comfortable with image acquisition and 68% (56/83) with image interpretation. APPs were less comfortable with POCUS image interpretation and clinical integration of POCUS findings compared to residents (χ²: 16.3, p < 0.0001 and χ²: 5.1, p = 0.02, respectively). 65% (54/83) of clinicians would use POCUS more if real-time supervision via tele-US was available for image acquisition and image interpretation. EM clinicians indicated a substantial need for further real-time POCUS training and supervision, especially for image interpretation. A clinician-centered strategy, such as tele-US, has potential to increase proficient use of POCUS.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1901-1908"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583182","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":"Out-of-hospital onset versus in-hospital onset for clinical outcomes in spontaneous intramuscular hematoma diagnosed by computed tomography: a retrospective cohort study.","authors":"Satoshi Sera, Yuji Okazaki, Kyungko Huh, Toshihisa Ichiba, Yuki Kataoka","doi":"10.1007/s11739-024-03819-w","DOIUrl":"10.1007/s11739-024-03819-w","url":null,"abstract":"<p><p>The aging global population and the increasing use of antithrombotic agents have made spontaneous intramuscular hematomas (SIH) a growing concern. The association between the settings of SIH onset and clinical outcomes remains unclear. The aim of this study was to determine these associations. A retrospective cohort study was conducted in a tertiary hospital in Hiroshima, Japan between January 2008 and January 2022. We included consecutive patients aged ≥ 15 years with SIH at any site diagnosed by computed tomography. The subjects were divided into two groups according to onset settings: out-of-hospital onset and in-hospital onset. The main outcome was treatment failure (composite of change in initial treatment and in-hospital death), and in-hospital mortality was also assessed. We used inverse probability of treatment weighting (IPTW) to estimate the causal effects of onset settings on outcomes. Of 84 included subjects with SIH, 63 had out-of-hospital onset and 21 had in-hospital onset. One subject (1.6%) with out-of-hospital onset and four subjects (19%) with in-hospital onset experienced treatment failure. In the IPTW cohort, in-hospital onset was associated with treatment failure [odds ratio (OR) 29, 95% confidence interval (CI) 7.2-270]. In addition, one subject (1.6%) with out-of-hospital onset and three subjects (14%) with in-hospital onset died during hospitalization. In-hospital onset was associated with a high rate of in-hospital mortality (OR 25, 95% CI 6.3-240) in the IPTW cohort. SIH with in-hospital onset had a poorer prognosis than that of SIH with out-of-hospital onset, suggesting that onset setting might be a novel predictor of clinical outcomes for SIH.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1941-1948"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644177","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":"Association between post-arrest 12-lead electrocardiographic features and neurologically intact survival for patients of in-hospital cardiac arrest: comment.","authors":"Yunlong Song, Rongchao Fang, Bo Yu","doi":"10.1007/s11739-025-04066-3","DOIUrl":"10.1007/s11739-025-04066-3","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1677-1678"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753268","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":"Considering frailty and meaningful outcomes in geriatric emergency care.","authors":"James D van Oppen, Simon Mooijaart, Christian H Nickel, Simon Conroy","doi":"10.1007/s11739-025-03940-4","DOIUrl":"10.1007/s11739-025-03940-4","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1973-1975"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788205","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":"Alkaptonuria: a rare disorder associated with common conditions.","authors":"Adrián Arapiles-Muñoz","doi":"10.1007/s11739-025-03986-4","DOIUrl":"10.1007/s11739-025-03986-4","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1965-1966"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186908","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}