Internal and Emergency Medicine最新文献

{"title":"The role of point-of-care ultrasound in the evaluation and management of hyponatremia: a systematic review.","authors":"Francisco Javier Del Castillo Tirado, Laisa Socorro Briongos Figuero, Samuel García-Rubio, Yale Tung-Chen, Luis Matías Beltrán Romero","doi":"10.1007/s11739-025-04256-z","DOIUrl":"10.1007/s11739-025-04256-z","url":null,"abstract":"<p><p>Hyponatremia is the most common electrolyte disorder. Accurate assessment of extracellular fluid volume status (hypovolemic, euvolemic, or hypervolemic) is essential for determining the underlying etiology and guiding treatment. Point-of-care ultrasound (PoCUS) has emerged as a complementary bedside tool to objectively assess volume status in hyponatremia. We systematically reviewed the relevant literature up to June 2025. The aim of this systematic review was to evaluate the role of PoCUS in the assessment and management of hyponatremia. The evidence suggests that combined lung, cardiac, and abdominal PoCUS (including the venous excess ultrasound score, VExUS) helps overcome the limitations of physical examination. PoCUS leads to a more accurate etiologic diagnosis and optimized treatment. PoCUS also aids in monitoring treatment response, enabling real-time adjustment of diuretics or fluids based on serial examinations. Its role may be limited by operator dependency and inability to detect non-ultrasound-revealed pathologies such as hypothyroidism. Integrating bedside ultrasound into hyponatremia management improves volume assessment accuracy and supports a more individualized approach. Although current evidence is mainly derived from small studies and case series, findings consistently support using PoCUS as an adjunct to traditional evaluation.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"831-842"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959205","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":"LINC00963 targeting miR-98-5p exacerbates sepsis-induced myocardial injury.","authors":"Yanling Chen, Xinming Li, Xiemuziya Maimaitirexiati, Chan Li, Huijing Zhao, Zhenling Gao","doi":"10.1007/s11739-025-04236-3","DOIUrl":"10.1007/s11739-025-04236-3","url":null,"abstract":"<p><p>The aim is to investigate the value and mechanism of action of LINC00963 in septic cardiomyopathy (SCM). A total of 85 patients with cardiomyopathy (control group) and 108 SCM patients were enrolled. An in vitro model was created by treating cardiomyocytes with 1 μg/mL of LPS. A sepsis mouse model was created using cecal ligation and puncture (CLP). Cox analysis was used to identify factors independently influencing mortality. Kaplan-Meier curves were used to record patient prognosis. RT-qPCR was used to detect gene expression. CCK8 and flow cytometry were employed to evaluate cell function. ELISA was used to detect inflammatory factor expression. Dual luciferase reporter and RIP validation were employed to confirm gene-targeted interactions. Upregulation of LINC00963 was observed in serum from patients with septic cardiomyopathy, heart tissue from septic mice, and LPS-infected cardiomyocytes, while miR-98-5p was downregulated. Patients with high LINC00963 expression had lower survival rates and were more likely to experience fatal outcomes. Both LINC00963 and BNP/NT-proBNP were both independent factors influencing patient mortality, and it was predicted that miR-98-5p was a target gene of LINC00963. Following si-LINC00963 transfection, apoptosis was reduced and inflammatory levels decreased in cardiomyocytes and myocardial tissue from sepsis-induced mice, and miR-98-5p was downregulated. However, the use of a miR-98-5p inhibitor reversed the cellular functional and inflammatory changes induced by LINC00963 knockdown. Knocking down LINC00963 reduces apoptosis and inflammation levels, and promotes cell proliferation by targeting miR-98-5p. This reduces the damage caused by sepsis to cardiomyocytes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"877-893"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966280","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":"Implementation of a psychological intervention for delirium prevention in elderly inpatients: results of a pilot real life study in internal medicine setting.","authors":"Fiammetta Cosci, Giada Gensini, Laura Xhani, Chiara Bernacchi, Giovanni Mansueto, Stefano Romagnoli, Anna Lo Cricchio, Maria Cristina De Sanctis, Alberto Moggi Pignone, Giulia Bandini","doi":"10.1007/s11739-025-04246-1","DOIUrl":"10.1007/s11739-025-04246-1","url":null,"abstract":"<p><p>Delirium in elderly inpatients needs to be prevented being associated with worse clinical outcome and higher cost burden. Effects of a structured intervention aimed at cognitive stimulation and reorientation to prevent delirium occurrence were tested. A nonrandomized stepped-wedge study was conducted. Patients were consecutively enrolled from 07/05/2024 to 03/10/2024 at an Internal Medicine Unit. Eligibility was verified based on inclusion criteria: age ≥ 65 years; hospitalization at the Unit; and exclusion criteria: personal history of dementia or cognitive impairment; delirium at admission. Demographic and clinical data were collected at enrollment. Delirium was assessed daily via the 4AT. Inpatients received a protocol-driven intervention aimed at cognitive stimulation and reorientation (cases) or usual care (controls). The intervention was administered daily from day 1 of hospitalization to discharge. A total of 222 subjects were evaluated (104 received the intervention, 118 had usual care). Males and females were equally distributed (54 males under the intervention, 62 males under usual care). Mean age was 81·54 ± 8·28 yrs among those who received the intervention and 81·24 ± 8·84 yrs among those under usual care. The two groups differed for delirium incidence: 7·69% (n = 8) among those who received the intervention and 22·03% (n = 26) among those who received usual care. The findings of the pilot study should be interpreted as preliminary feasibility results rather than evidence of efficacy. They need replication in larger samples, being promising in terms of implementation of the intervention in real life of Internal Medicine Units.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"919-926"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906033","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":"Can a science endorse its antithesis? Medicine and the homeopathy paradox.","authors":"Francesco M Galassi, Elena Varotto, Roberto Burioni","doi":"10.1007/s11739-026-04262-9","DOIUrl":"10.1007/s11739-026-04262-9","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"805-806"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146062766","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":"Red blood cell distribution width and blood transfusions are associated with 2-year mortality after transcatheter aortic valve implantation in males but not in females: sex-related differences in hematological predictors.","authors":"Alice Vianello, Anna Piccoli, Gabriele Pesarini, Silvia Mengon, César Federico Vigo, Giacomo Marchi, Claudia Bozzini, Sabrina Genesini, Fabio Chesini, Giovanni Benfari, Giuseppe Lippi, Domenico Girelli, Flavio Luciano Ribichini, Fabiana Busti","doi":"10.1007/s11739-026-04267-4","DOIUrl":"10.1007/s11739-026-04267-4","url":null,"abstract":"<p><p>Preoperative anemia, transfusions, and simple hematological parameters like red blood cell distribution width (RDW) have been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI), with some heterogeneity of results. Hemoglobin (Hb) levels are physiologically different in males and females, and sex differences are increasingly recognized to play an important role in the prognosis of many cardiovascular diseases, including aortic valve stenosis. We aimed to evaluate the prognostic role of preoperative anemia, RDW, and periprocedural transfusions in TAVI patients followed up to 2 years, especially focusing on sex-related differences. 609 patients (median age 83 years, 53.9% females) undergoing TAVI at Verona University Hospital between March 2010 and June 2019 were retrospectively evaluated. Anemia before TAVI was highly prevalent (55.0%) in our population, mostly mild to moderate. Females were less anemic than males (48.8% versus 62.3%, p = 0.001) but experienced more vascular complications and were more frequently transfused within 30 days of the procedure (43.3% versus 28.8%, p < 0.001). Overall, anemic patients at baseline had a 2-year survival lower than non-anemic patients (Log-rank 5.915, p = 0.015). Similarly, patients with baseline RDW > 15% had reduced survival at 2 years compared to patients with normal RDW (Log-rank 14.038, p < 0.001). Grouping for sex, these differences only persisted in males. Multivariable analyses showed that hematological variables, such as periprocedural transfusions and RDW, were significant predictors of 2-year mortality in males but not in females. Our study highlights significant sex-related differences in the role of hematological parameters as independent predictors of 2-year mortality after TAVI.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"979-991"},"PeriodicalIF":3.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270988","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":"In-hospital outcomes among patients admitted for myocardial infarction with coexisting respiratory syncytial virus versus influenza infections.","authors":"Conner E Johnson, Whitney B Sussman, Erin R Weeda","doi":"10.1007/s11739-026-04335-9","DOIUrl":"https://doi.org/10.1007/s11739-026-04335-9","url":null,"abstract":"<p><p>Among patients with myocardial infarction, influenza infection increases the risk of severe complications and mortality, likely driven by combined inflammatory and cardiovascular stress. Little is known about coexisting respiratory syncytial virus (RSV) infection among those presenting with myocardial infarction. This study aimed to investigate whether in-hospital outcomes differ among patients admitted for myocardial infarction with coexisting RSV versus influenza infections. Using the 2016-2022 United States National Inpatient Sample, we identified all individuals admitted for myocardial infarction. Only those with coexisting RSV or influenza infections were included. In-hospital outcomes were compared among those with RSV versus influenza. We identified 3966 patients with myocardial infarction in the database meeting our inclusion criteria, of which 565 had coexisting RSV and 3401 had coexisting influenza infections. In-hospital mortality occurred in 5.7% of individuals with RSV and 5.8% of individuals with influenza infections. The average length of hospital stay in all patients was approximately 7 days for both those with RSV and those with influenza. After adjusting for covariates, there was no difference in mortality (odds ratio [OR] = 0.925;95% confidence interval [CI] = 0.620-1.382), in-hospital complications (OR = 0.973;95%CI = 0.738-1.282), or LOS (mean difference = 0.17; 95%CI = - 0.30 to 0.64). In conclusion, this study found no significant difference in in-hospital mortality or length of stay between patients with myocardial infarction coexisting with RSV versus influenza infections. Given the established role of influenza in exacerbating myocardial infarction severity, greater recognition and investigation of RSV co-infections in this high-risk population are likely needed.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591994","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 of tirzepatide, lanifibranor, and resmetirom in metabolic dysfunction-associated steatotic liver disease: a meta-analysis of high-quality randomized controlled trials.","authors":"Shuai Zhao, Fei Tian, Lan Yu, Zhenhua Li, Jing Hou, Yaochen Wei, Haozhe Cui, Shuqing Cui, Xiangming Ma","doi":"10.1007/s11739-026-04326-w","DOIUrl":"https://doi.org/10.1007/s11739-026-04326-w","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a highly prevalent condition and a leading cause of chronic liver disease worldwide. Several pharmacological agents are currently used in its clinical management. This meta-analysis assesses the comparative efficacy and safety profiles of three novel therapeutic agents-tirzepatide (a dual GIP/GLP-1 receptor agonist), lanifibranor (a pan-PPAR agonist), and resmetirom (a thyroid hormone receptor-β agonist)-in patients with MASLD/MASH.We systematically searched PubMed, Scopus, Web of Science, the Cochrane Library, and Embase from inception to December 31, 2024. Eligible randomized controlled trials (RCTs) were those that enrolled adults with MASLD/MASH and compared tirzepatide, lanifibranor, or resmetirom with placebo. Non-randomized trials, animal studies, trials using only imaging or biomarkers for diagnosis, studies without a placebo arm, and those including subjects aged < 18 years were excluded. Methodological quality was assessed using the Cochrane Risk of Bias 2.0 tool. Data synthesis was performed using RevMan 5.3. The protocol was registered with PROSPERO (CRD 42025637054). Five placebo-controlled trials met the inclusion criteria: one for tirzepatide (NCT04166773), one for lanifibranor (NCT04849728), and three for resmetirom (NCT03900429, NCT04197479, NCT04951219). The analysis included 2497 individuals (1112 [45%] male, mean age 55.6 years [SD 11.6], mean BMI 35.3 kg/m² [SD 6.3], and 1385 [55%] with diabetes). All agents led to MASH resolution without worsening of fibrosis in a proportion of patients, with significant effects observed for tirzepatide and resmetirom. Tirzepatide (mean difference [MD] - 34.90% [95% CI: - 53.31 to - 16.49]) and resmetirom (MD - 31.45% [95% CI: - 35.93 to - 26.97]) significantly reduced hepatic steatosis as assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF). Tirzepatide significantly reduced serum aminotransferase levels (ALT: MD - 30.90%, p < 0.00001; AST: MD - 20.71%, p < 0.00001). Although lanifibranor demonstrated improvements in lipid profiles (HDL-C + 9.87%, triglycerides - 26.90%), it did not achieve a statistically significant improvement in fibrosis (OR 1.26, p = 0.08). Gastrointestinal adverse events were frequently reported across all treatment arms. Tirzepatide and resmetirom significantly improved MASH resolution without worsening of fibrosis and reduced hepatic steatosis. All three agents lowered serum aminotransferase levels, while lanifibranor and resmetirom improved lipid profiles. Gastrointestinal adverse events were common, which may affect tolerability. Due to the limited number of trials for tirzepatide and lanifibranor, further large-scale studies are warranted to confirm their role in MASLD/MASH management.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591964","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":"Documentation of high blood pressure measurements in the emergency department: factors associated with discussion and comparison to other settings.","authors":"Cole G Chapman, Brett A Faine, Barry L Carter, David A Talan, Philip M Polgreen, Linnea A Polgreen","doi":"10.1007/s11739-026-04325-x","DOIUrl":"https://doi.org/10.1007/s11739-026-04325-x","url":null,"abstract":"<p><p>Asymptomatic hypertension is common among emergency department (ED) patients. However, follow-up occurs infrequently. Because recognition of elevated readings is a prerequisite for referrals, we investigated the factors associated with the documentation of elevated BP measurements in provider notes. Electronic medical record (EMR) data from the University of Iowa Healthcare system were used to identify patients who had an outpatient ED, primary care, or urgent care visit with high BP (140/90 mmHg or greater) from 01 January 2017 through 31 December 2021 and no prior hypertension diagnosis. We measured whether clinical notes from each visit mentioned hypertension or high BP and modeled the probability of that event across visits in ED, urgent care, and primary care settings. Covariates included the busyness of the care setting at the time of the visit, patient demographics, visit vitals and diagnoses. We identified 13,777 distinct patients with 18,036 ED visits, 3564 urgent care visits, and 27,895 primary care visits. Patient BP was discussed in the notes for 27% of ED visits compared to 51% of visits for both primary and urgent care. High BP was more likely to be mentioned in ED visit notes when the visit included diagnoses indicating chest pain and during times when the ED was substantially less busy than normal. High BP was also more likely to be mentioned in notes of the ED for patients with any prior diagnosis code of nonhypertension-related elevated BP. High BP levels are frequently not discussed in clinical and discharge notes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580428","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":"Sepsis accelerates frailty and functional decline in older adults: a 12-month prospective study.","authors":"Ian López-Cruz, José Luis García-Giménez, Laura Piles, Judit Garcia, Manuel Madrazo, Federico Vicente Pallardó, Arturo Artero","doi":"10.1007/s11739-026-04330-0","DOIUrl":"https://doi.org/10.1007/s11739-026-04330-0","url":null,"abstract":"<p><p>Sepsis, a life-threatening infection-induced condition, is a leading cause of mortality worldwide, particularly among older adults. Survivors often experience long-term health complications, including decline in functional capacity, cognitive impairment, and worsening of chronic comorbidities. This study aimed to evaluate the impact of sepsis on frailty and functional status over 12 months in patients with community-acquired infections. 50 patients completed the follow-up and were analyzed: 24 in the sepsis group and 26 in the control group, matched by age, sex, and infection source. Functional status was assessed at baseline and 12 months using the Barthel Index, Lawton Scale, and FRAIL questionnaire. At 12 months, septic patients showed significant declines in both functional capacity and frailty. Specifically, there was a significant decline in functional independence as measured by the Lawton Scale, with 33.3% of septic patients exhibiting reduced ability in instrumental activities of daily living, compared to 11.7% in controls (p = 0.032). FRAIL scale showed significant worsening in the sepsis group (41.7% vs. 7.7%, p = 0.005). Notably, 33.3% of previously robust septic patients developed new frailty, compared to 0% in the control group (p = 0.025). The study also found a significant increase in comorbidity burden at 12 months within the sepsis group (p = 0.041), whereas between-group differences were not statistically significant. These results highlight the long-term impact of sepsis on functional capacity and frailty, emphasizing the need for targeted post-sepsis rehabilitation and management.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574029","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":"Clinical significance of head CT scan in patients admitted to the emergency department with mild head trauma.","authors":"Marco Baldrighi, Luca Molinari, Demetrio Luzzi, Alice Rubinetti, Danila Azzolina, Luca Rousseau, Domenico Urzia, Alessandra Galbiati, Michela Beltrame, Martina Alfano, Francesca Maria Giolitti, Claudia Cicerone, Giacomo Iannantuoni, Luigi Mario Castello, Filippo Patrucco, Pier Paolo Sainaghi, Gian Carlo Avanzi, Mattia Bellan, Francesco Gavelli","doi":"10.1007/s11739-026-04314-0","DOIUrl":"https://doi.org/10.1007/s11739-026-04314-0","url":null,"abstract":"<p><p>Head computed tomography (CT) scan is the gold standard for early diagnosis of brain injuries in the Emergency Department (ED), but clinically important injuries after a mild head trauma (MHT) are rare. This study aims to evaluate the impact of head CTs on the management of patients presenting to the ED with MHT. In this prospective observational study, we enrolled adult patients admitted to the ED of a medium-size University Hospital for MHT. Patients were evaluated at the time of admission and then at 6-24-48-72 h (if still in the ED). A 90-day telephone follow-up was performed. The primary composite endpoint was a change in patients' management (hospitalization, modifications in pharmacotherapy or invasive treatments) following a CT. Between June 2021 and July 2023 we enrolled 508 patients. At least 1 CT was performed in 454 patients (89.4%), and the first CT revealed a brain injury in 87 (19.2%) of them. At least another CT was repeated in the first 24 h in 144 patients; delayed injuries were observed in 4 cases only, with no clinical impact. The cumulative number of CTs performed throughout the study was 620, but only 24 of them (3.9%) had a clinical impact, and none of the patients underwent neurosurgery. The incidence of intracranial injuries requiring admission or treatments was 4.5%. In conclusion, the incidence of brain injuries requiring treatment was very low, and most of the CTs had no clinical impact.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147528760","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}