Internal and Emergency Medicine最新文献

{"title":"Doctor-patient communication in community-dwelling patients with essential hypertension: a cross-sectional study.","authors":"Tao Liu, Hancheng Li, Minghao Xing, Yufeng Shu, Huizhen Zhou, Jingjia Yu, Weihong Jiang","doi":"10.1007/s11739-025-04167-z","DOIUrl":"10.1007/s11739-025-04167-z","url":null,"abstract":"<p><p>This study aimed to assess the doctor-patient communication among hypertensive patients in the context of community health service and chronicity of the disease, and to highlight which demographic and clinical factors may make this task less effective for the doctor. The study was conducted at two community hospitals in Changsha, China, from January 1 to November 1, 2024. Set Elicit Give Understand End (SEGUE) framework and a self-developed questionnaire were used to assess doctor-patient communication and hypertension-related content. Multivariable logistic regression was employed to analyze associated factors. We collected 546 valid questionnaires, primarily from elderly individuals with over 10 years of hypertension history. The average SEGUE score was 68.80 ± 16.17, with 70.7% of patients having suboptimal communication (SEGUE score < 80). Hypertension-related communication content between doctors and patients was considered insufficient. Only 65.6% of patients reported that doctors discussed the importance of medication for blood pressure control, and 22.0% reported that they were explained the potential side effects of their medication. Factors associated with worse doctor-patient communication included obesity (BMI > 28 kg/m²; OR = 0.32, 95% CI 0.17-0.60) and a longer duration of hypertension (< 10 years; OR = 0.58, 95% CI 0.34-0.97). Conversely, better communication was also associated with a high school or higher education level (OR = 2.38, 95% CI 1.17-4.86), higher monthly income (2000-4000 yuan: OR = 2.11, 95% CI 1.18-3.77; > 4000 yuan: OR = 2.42, 95% CI 1.21-4.87), and better cognitive function (higher MMSE score; OR = 1.74, 95% CI 1.53-1.99). Most of the hypertensive patients perceived suboptimal doctor-patient communication. Factors associated with this included BMI, hypertension duration, education level, income, and cognitive function.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2291-2299"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470910","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":"CGRP-targeted therapies for migraine and the risk of infection.","authors":"Claudio Tana, Bianca Raffaelli, Roberta Messina, Raffaele Ornello, William Wells-Gatnik, Paolo Martelletti, Livia Moffa","doi":"10.1007/s11739-026-04403-0","DOIUrl":"10.1007/s11739-026-04403-0","url":null,"abstract":"<p><p>The introduction of CGRP-pathway inhibitors has markedly changed the management of migraine, providing effective and well-tolerated options for many patients who were previously difficult to treat. Their overall safety profile appears favorable; however, emerging observations have prompted questions regarding possible infectious complications related to CGRP blockade. This review summarizes the available evidence on infection risk associated with CGRP-targeted therapies, integrating data from randomized clinical trials, post-marketing pharmacovigilance, and experimental immunological studies. While no consistent signal of increased infections has been observed in controlled trials, real-world data and mechanistic considerations suggest that interference with CGRP pathways might, under certain conditions, influence host immune defense. Although infections remain uncommon, awareness of this potential risk is important, particularly in patients with pre-existing immunological frailty or multiple comorbidities. Ongoing surveillance and focused clinical studies will be essential to clarify these aspects and guide safe, long-term use of CGRP inhibitors in everyday clinical practice.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2001-2013"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029947","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":"Systematic review of diagnostic test accuracy of point-of-care gastric ultrasound by emergency physicians.","authors":"Robert James Adrian, Peter Alsharif, Marwa Ali, Stephen Alerhand","doi":"10.1007/s11739-026-04454-3","DOIUrl":"10.1007/s11739-026-04454-3","url":null,"abstract":"<p><p>Gastric ultrasound (GUS) has been used by anesthesiologists, critical care physicians, and radiologists for various clinical applications. Emergency physicians have begun to adopt this technique to the emergency setting. This study aims to determine the diagnostic test characteristics of GUS for prandial status by emergency physicians. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Diagnostic Test Accuracy (PRISMA-DTA) guideline, we conducted a systematic review of diagnostic test characteristics of emergency physician-performed GUS for prandial status. We identified nine studies (n = 659) of emergency physician-performed GUS. Four studies evaluated adults (n = 173) and five studies evaluated pediatric patients (n = 486). Based on QUADAS-2 definitions, studies were highly applicable. However, studies were of low to very low quality and at a high risk of bias. In adults, GUS was 86-100% sensitive and 70-92% specific for prandial status, with 100% feasibility. In pediatric patients, GUS was 82-84% sensitive and 22-74% specific for prandial status, with 85-100% feasibility. In most cases, GUS was performed in less than 5 min. In the studies identified by this systematic review, point-of-care GUS by emergency physicians was highly feasible across adult and pediatric populations. This imaging modality has fair to excellent test characteristics for assessing prandial status in adults. Test characteristics in pediatric patients ranged from very poor to good. Accordingly, GUS is a potentially helpful adjunct for assessing gastric content and volume (i.e., full vs. empty stomach) that would benefit from further prospective investigation. Nevertheless, caution should be adopted prior to incorporating GUS into clinical decision making.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2211-2219"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420895","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":"Targeting triglycerides for cardiovascular risk reduction.","authors":"Carlo Maiorca, Daniele Tramontano, Alessia Di Costanzo, Laura D'Erasmo","doi":"10.1007/s11739-026-04383-1","DOIUrl":"10.1007/s11739-026-04383-1","url":null,"abstract":"<p><p>Residual cardiovascular risk persists in many patients despite optimal control of established factors such as low-density lipoprotein cholesterol (LDL-C), blood pressure and glycaemia. Mounting evidence indicates that hypertriglyceridemia (HTG) and triglyceride-rich lipoproteins (TRLs), including their remnant particles, contribute to atherogenesis and therefore constitute actionable targets for risk reduction. This narrative review summarizes current knowledge of TRL metabolism and its role in atherosclerotic cardiovascular disease (ASCVD), drawing on mechanistic studies, observational cohorts and Mendelian-randomization analyses. TRLs display pro-inflammatory and pro-thrombotic properties and are increasingly implicated in plaque initiation and progression. Traditional and emerging therapeutic strategies designed to lower TRL burden are critically examined with particular emphasis on their ability to address residual cardiovascular risk. Conventional interventions, fibrates and mixed omega-3 fatty-acid formulations, have yielded modest and inconsistent cardiovascular benefits. By contrast, icosapent ethyl, a highly purified ethyl ester of eicosapentaenoic acid, is the only TRL-targeted therapy that has demonstrated a significant reduction in major cardiovascular events in a large, randomized trial, irrespective of baseline triglyceride levels. Novel agents such as evinacumab (an ANGPTL3 monoclonal antibody) and antisense oligonucleotides against apolipoprotein C-III (volanesorsen, olezarsen, plozasiran) have produced marked decreases in triglycerides, apoB-containing lipoproteins and remnant cholesterol in recent clinical studies, even though cardiovascular outcome data are not yet available. Therefore, therapies targeting TRL metabolism represent a promising approach to reduce residual cardiovascular risk, particularly in high-risk or statin-treated patients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1961-1977"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972264","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":"The systemic immune-inflammation biomarkers in Sjögren's disease: associations with disease activity and extraglandular manifestations in a multicentric Italian cohort.","authors":"Stefano Stano, Venerito Vincenzo, Maria Giannotta, Fabio Cacciapaglia, Daniele Catamerò, Maria Iacovantuono, Paola Conigliaro, Benedetta Monosi, Daniele Domanico, Eduardo Urgesi, Antonio Vitale, Maria Sole Chimenti, Florenzo Iannone, Giuseppe Lopalco","doi":"10.1007/s11739-026-04394-y","DOIUrl":"10.1007/s11739-026-04394-y","url":null,"abstract":"<p><p>Sjögren's disease (SjD) is an autoimmune exocrinopathy characterized by heterogeneous extraglandular manifestations (EGM). The systemic immune-inflammation biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), have been proposed as indicators of the inflammatory burden, but data in SjD remain limited. This retrospective multicenter Italian study aimed to evaluate the NLR, PLR, and SII in exocrine SjD patients and across specific EGM. Consecutive patients fulfilling the 2016 ACR/EULAR classification criteria for SjD and with available full blood count data were included. Patients were classified as having exocrine or extraglandular SjD according to the presence of specific EGM. The NLR, PLR, and SII were calculated and compared across disease phenotypes and activity levels. Among 239 SjD patients (96% female, median age 59 years), 70% presented at least one EGM. Extraglandular SjD patients had longer disease duration (p = 0.04) and higher frequencies of hypergammaglobulinemia (p = 0.05), anti-nuclear antibodies (p = 0.0003), anti-SSA antibodies (p = 0.04), and rheumatoid factor (p = 0.04). Overall, the median NLR, PLR, and SII did not differ between exocrine and extraglandular SjD. However, patients with arthritis showed higher NLR (p = 0.02), PLR (p < 0.05), and SII (p = 0.005), while patients with interstitial lung disease displayed higher SII (p = 0.01). Extraglandular SjD patients with moderate-to-high disease activity showed increased NLR and SII (p = 0.004, for both). Systemic immune-inflammation biomarkers are inexpensive, readily available and easy to calculate. The NLR, PLR, and SII are associated with specific inflammatory phenotypes and higher disease activity in Italian SjD patients. Prospective studies are warranted to confirm these preliminary findings.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2109-2119"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987300","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":"The illusion of choice: financial toxicity and the paradox of systemic therapy in advanced HCC within resource-limited settings.","authors":"Hassan Aziz, Nawal Adnan, Muhammad Junaid Patel","doi":"10.1007/s11739-026-04356-4","DOIUrl":"10.1007/s11739-026-04356-4","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2363-2364"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716370","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 esophageal necrosis: serial endoscopic documentation of rapid mucosal restoration.","authors":"Hiroaki Nishioka, Shohei Fujita","doi":"10.1007/s11739-026-04391-1","DOIUrl":"10.1007/s11739-026-04391-1","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2341-2342"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963545","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":"Heart involvement in alcohol use disorder: observational and retrospective study in a specialized hospital unit and long-term follow-up.","authors":"Margherita Vergadoro, Erika Zola, Giovanni Gottardi, Simona Di Liberto, Anna Chiara Frigo, Luca Fabris, Paolo Simioni","doi":"10.1007/s11739-026-04367-1","DOIUrl":"10.1007/s11739-026-04367-1","url":null,"abstract":"<p><p>Although growing attention has been drawn to alcohol-related heart damage, several clinical aspects, including prevalence and outcome of alcoholic cardiomyopathy (ACM) and atrial fibrillation (AF) in patients with alcohol use disorder (AUD) remain elusive. This study investigated the clinical impact of ACM and AF on AUD patients in the setting of an internal medicine unit. We retrospectively analyzed 291 consecutive patients admitted for AUD at a single specialized center for AUD diagnosis and treatment, affiliated with an internal medicine unit. We included patients who underwent echocardiographic evaluation following hospital admission. Demographic data, comorbidities, alcohol-related organ damage, and ECG findings were collected to diagnose AF and ACM and to assess their clinical impact. Among 291 patients undergoing echocardiography and ECG, 239 were males (82.1%). They were categorized into patients with (n = 42, Group A) and without ACM (n = 249, Group B). The prevalence of ACM was 14.4%, whereas AF was found in 19.1%. ACM patients were asymptomatic in 28.6% of cases. Among comorbidities, significant differences were observed in the prevalence of type 2 diabetes (7.1% in Group A, 21.2% in Group B, p = 0.0329). Risk of mortality was significantly influenced by AF, but not by ACM. A significant proportion of AUD inpatients were diagnosed with ACM (about 14%, 95% men) and AF (19.1%, 88.9% men), which only affected mortality. Notably, more than a quarter of ACM patients were asymptomatic for heart failure supporting the value of echocardiographic assessment even when overt heart failure was absent. By survival analysis, AF rather than ACM emerged as an adverse prognostic factor. These findings support a structured cardiac evaluation in hospitalized patients with AUD.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2015-2027"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814478","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":"PoCUS-first versus CT-only for non-traumatic abdominal pain: a propensity score-weighted cohort study on ED resource utilization.","authors":"Te-Fa Chiu, Tse-Chyuan Wong, Fen-Wei Huang, Eric H Chou, Jon Wolfshohl, Kuan-Fu Chen, Wei-Jun Lin, Shih-Hao Wu","doi":"10.1007/s11739-025-04164-2","DOIUrl":"10.1007/s11739-025-04164-2","url":null,"abstract":"<p><p>Point-of-care ultrasound (PoCUS) may reduce emergency department (ED) length of stay (LOS) for selected abdominal diagnoses, but its role in undifferentiated, non-traumatic abdominal pain remains uncertain. This study compared PoCUS-first and CT-only strategies, evaluating associations with resource use and clinical outcomes in adult ED patients. This propensity score-weighted cohort study included adults (≥ 18 years) presenting with non-traumatic abdominal pain to the ED of a tertiary medical center in Taiwan between January 2021 and December 2023. Patients transferred or discharged against medical advice from other facilities were excluded. Encounters were classified as PoCUS-first (PoCUS alone and followed by CT) or CT-only. Primary outcomes were ED LOS and costs; secondary outcomes were unscheduled return visit (URV), hospital LOS, total costs, ICU admission, and in-hospital mortality. Multivariate regression and inverse probability of treatment weighting (IPTW) adjusted for baseline differences. Among 26,403 index ED visits, 67.5% received PoCUS‑first evaluation and 32.5% underwent CT only. After adjustment, PoCUS‑first was associated with substantially shorter ED LOS (ratio of means 0.53, 95% CI 0.52-0.54; 47% reduction), lower ED costs (0.52, 95% CI 0.51-0.53; 48% reduction), fewer consultations, and reduced admission rates. In patients discharged at the index visit (n = 17,390), PoCUS‑first was similarly linked to shorter LOS (0.61, 95% CI 0.60-0.62; 39% reduction), markedly lower costs (0.47, 95% CI 0.46-0.47; 53% reduction), and decreased odds of unscheduled return visits (OR 0.82, 95% CI 0.69-0.96), without an increase in adverse outcomes. For patients later admitted after a return visit, PoCUS‑first encounters were characterized by lower resource use during the index ED visit, with no evidence of prolonged subsequent care or safety concerns. A PoCUS‑first strategy, used for initial risk stratification, was associated with greater ED efficiency and more judicious resource use without compromising safety. However, the observed reduction in ED LOS may partly reflect local workflow and in‑house processes, and residual confounding cannot be excluded. Confirmation in prospective, multicenter studies is warranted.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2279-2289"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377336","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":"Distinct pain profiles across irritable bowel syndrome subtypes: results from the Rome Foundation Global Epidemiology Study.","authors":"Keren Hod, Giovanni Marasco, Luigi Colecchia, Ami D Sperber, Olafur S Palsson, Shrikant I Bangdiwala, Giovanni Barbara","doi":"10.1007/s11739-026-04375-1","DOIUrl":"10.1007/s11739-026-04375-1","url":null,"abstract":"<p><p>Abdominal pain is the hallmark symptom of irritable bowel syndrome (IBS), yet its clinical expression varies considerably across subtypes. Despite this, few large-scale studies have compared pain features across all Rome IV-defined IBS subtypes. We aimed to delineate differences in abdominal pain patterns across IBS subtypes and evaluate the contribution of psychological comorbidities, extra-intestinal symptoms, and intermediate factors associated with psychological distress. Data were derived from the internet survey of the Rome Foundation Global Epidemiology Study, encompassing 54,127 participants from 26 countries, including 2195 IBS patients [712 constipation-predominant IBS (IBS-C), 629 diarrhea-predominant IBS (IBS-D), 712 mixed-type IBS (IBS-M), 142 unclassified-IBS (IBS-U)]. Clinical, dietary, and psychological parameters were assessed using validated questionnaires. Mediation analysis examined whether the association between IBS and psychological distress was attenuated after inclusion of illness perception, food avoidance, and work/activity impairment. IBS-C patients exhibited longer, more severe, and widespread pain, often radiating to the back and associated with greater analgesic use, while pain in IBS-D patients was linked to stool frequency and consistency changes. IBS-C patients reported greater dissatisfaction with bowel function, IBS-U patients frequently identified abdominal pain and bloating/distention as their most bothersome symptom. Psychological distress and somatic symptom burden were prevalent across all subtypes (69-78% and mean scores of 8.3-95, respectively). Mediation analyses revealed partial indirect associations of concerns about bowel function, embarrassment, and work/activity-related impairment, but not food avoidance. IBS subtypes demonstrate distinct pain and psychosocial profiles. Psychological burden is partly accounted for by illness perceptions and work/activity impairment, emphasizing importance of personalized, multimodal management strategies.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"2065-2075"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837473","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}