Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine最新文献

{"title":"Biomarkers in predicting mortality among hemodialysis patients: recent advances.","authors":"Davide Ramoni, Alessandro Scuricini, Luca Liberale, Federico Carbone, Fabrizio Montecucco","doi":"10.20452/pamw.17351","DOIUrl":"10.20452/pamw.17351","url":null,"abstract":"<p><p>Patients undergoing maintenance hemodialysis face annual mortality rates of 15%-27%, with cardiovascular causes accounting for more than half of all deaths. Despite advances in dialytic technology, conventional prognostic models derived from the general population systematically underestimate risk in end‑stage renal disease, failing to capture the complexity of uremic pathophysiology that drives this excess mortality: immune dysregulation, chronic inflammation, oxidative stress, vascular calcification, uremic cardiomyopathy, protein‑energy wasting, and accelerated vascular aging. This narrative review synthesizes current evidence on biomarkers predicting all‑cause and cardiovascular mortality in hemodialysis patients, spanning established markers (albumin, C‑reactive protein, ferritin, hemoglobin, high‑sensitivity troponins, and N‑terminal pro-B‑type natriuretic peptide) to an emerging frontier encompassing interleukin‑6, pentraxin-3, soluble suppression of tumorigenicity‑2, galectin‑3, fibroblast growth factor-23, Klotho, and multiomics signatures. We further examine composite neutrophil‑derived indices, adipokines, and mineral metabolism markers as tools for pathway‑specific risk interrogation. The evidence converges on a clear practical message: combination and dynamic approaches are better than single, static measurements. Multibiomarker models consistently outperform individual markers, and longitudinal trajectories carry prognostic information (with divergence between survivors and nonsurvivors detectable many months before death) that a single time‑point value cannot replicate. Advances in artificial intelligence and multiomics further support this shift toward dynamic, personalized risk stratification, though these approaches remain at an early, largely exploratory stage. Critically, clinical translation remains limited by the lack of dialysis‑specific thresholds, poor standardization, and the absence of randomized evidence demonstrating that biomarker‑guided strategies improve outcomes. Bridging this gap between prognostic insight and clinical application remains the central challenge of precision nephrology.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation in cancer patients with atrial fibrillation: recent advances.","authors":"Danilo Menichelli, Flavio G Biccirè, Arturo Cesaro, Daniele Pastori","doi":"10.20452/pamw.17355","DOIUrl":"10.20452/pamw.17355","url":null,"abstract":"<p><p>Atrial fibrillation (AF) and cancer frequently coexist, particularly in elderly patients, creating a complex clinical scenario with increased thromboembolic and hemorrhagic risk. In these patients, in addition to established risk factors, cancer‑related factors, such as thrombocytopenia, organ dysfunction, and drug-drug interactions (DDIs), should be considered when managing anticoagulant treatment. Despite a growing prevalence of this clinical overlap, cancer patients have been under‑represented in randomized controlled trials of direct oral anticoagulants (DOACs) for AF. Consequently, evidence guiding anticoagulation decisions in this population derives largely from post hoc analyses and observational studies. The CHA2DS2‑VASc and Hypertension, Abnormal Renal / Liver Function, Stroke, Bleeding History or Predisposition scores, widely used for thromboembolic and bleeding risk stratification in the general AF population, demonstrated suboptimal predictive performance in cancer patients, underscoring the need for a risk factor-based approach specific for cancer patients. Emerging data consistently suggest that DOACs are at least as effective and safe as vitamin K antagonists in cancer patients with AF, with potential advantages in reducing the risk of stroke, major and intracranial bleeding, and mortality. However, DOAC use is still debated in some settings, such as gastrointestinal and genitourinary cancer, brain metastasis, and in the case of strong DDIs. This review summarizes current evidence on ischemic and bleeding risk assessment in cancer patients with AF, evaluates the performance of existing risk stratification tools, identifies cancer‑specific bleeding risk factors, and proposes a practical management algorithm for anticoagulation in this challenging population.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"136 9","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transthyretin cardiac amyloidosis beyond advanced age: 2 cases of unusually young patients.","authors":"Krzysztof Badura, Aleksander Baszkowski, Maciej Nadel, Joanna Kurzaj, Aleksander Misiewicz, Jarosław Drożdż","doi":"10.20452/pamw.17340","DOIUrl":"10.20452/pamw.17340","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":"1-3"},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular involvement and outcomes in Marfan syndrome: new observations on evolving aortic risk associations in a single-center cohort from Poland.","authors":"Agnieszka M Żebrowska, Przemysław Chmielewski, Ilona Kowalik, Joanna K Ponińska, Maciej K Michałowski, Ewa Michalak, Krzysztof Jaworski, Michalina Krych, Elżbieta Ciara, Ilona Michałowska, Rafał Płoski, Zofia T Bilińska","doi":"10.20452/pamw.17347","DOIUrl":"10.20452/pamw.17347","url":null,"abstract":"<p><strong>Introduction: </strong>Marfan syndrome (MFS) is a connective tissue disorder with aortic dilatation driving morbidity and mortality.</p><p><strong>Objectives: </strong>Our aim was to characterize cardiovascular profile, outcomes, and factors associated with the lifetime risk of thoracic aortic events (TAEs) in a contemporary MFS cohort.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed data from MFS patients diagnosed based on the revised Ghent criteria and followed for a median (interquartile range [IQR]) of 6.8 (3-10) years at our tertiary center.</p><p><strong>Results: </strong>The cohort comprised 151 patients (104 probands; median age [IQR], 32 [21-41] y; 58% women). Aortic root involvement was present in 95% of the patients, a positive family history in 69%, a systemic score of at least 7 points in 61%, and ectopia lentis in 36%. Among the patients with identified <i>FBN1</i> variants, 60% carried dominant‑negative and 40% haploinsufficiency variants, 27% of the variants were novel ones. Overall, 107 TAEs occurred in 85 patients (56%). The first TAE (median age, 33 [22-43] y) comprised 60 elective operations and 25 aortic dissections; 19 in previously undiagnosed individuals. TAE‑free survival was shorter in men and in patients with high systemic score, mainly before the age of 35 years, whereas in older patients haploinsufficiency variants were associated with TAEs. A second TAE occurred in 18 individuals (21%), and was more frequent after dissection than elective surgery (hazard ratio, 2.9; 95% CI, 1.2-7.1; <i>P</i> = 0.01). Mitral valve surgery was performed in 13% of the patients.</p><p><strong>Conclusions: </strong>The majority of MFS patients experienced a TAE. The association of TAE risk with factors, such as male sex, extra‑aortic features, and <i>FBN1</i> variant type, varied with age group.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney biopsy still rules the diagnosis of glomerular disease: new insights into trends in biopsy‑proven kidney disease in Poland.","authors":"Tomasz Stompór, Justyna Zbrzeźniak-Suszczewicz","doi":"10.20452/pamw.17405","DOIUrl":"https://doi.org/10.20452/pamw.17405","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal tuberculosis: a rare intra-abdominal manifestation mimicking malignancy.","authors":"Agnieszka Piątek-Guziewicz, Olga Kaczmarczyk, Albert Wróbel, Krzysztof Przęczek, Joanna Szpor, Michał Kukla","doi":"10.20452/pamw.17349","DOIUrl":"10.20452/pamw.17349","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac hemangioma presenting as a potential source of cerebral ischemic lesions.","authors":"Agnieszka Bartczak-Rutkowska, Zofia Oko-Sarnowska, Justyna Rajewska-Tabor, Hanna Wachowiak-Baszyńska, Piotr Buczkowski, Maciej Lesiak","doi":"10.20452/pamw.17326","DOIUrl":"10.20452/pamw.17326","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrections: Association between oxidative stress markers and hypofibrinolysis in atrial fibrillation.","authors":"","doi":"10.20452/pamw.17406","DOIUrl":"10.20452/pamw.17406","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seasonality analysis of inflammatory bowel disease exacerbations requiring hospitalization: a single-center, retrospective study from Poland.","authors":"Przemysław Kłos, Alicja Kaśniewska-Kosińska, Paulina Urynowicz, Katarzyna Płoszka, Ewa Małecka-Wojciesko, Adam Fabisiak","doi":"10.20452/pamw.17388","DOIUrl":"https://doi.org/10.20452/pamw.17388","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"136 9","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond thrombus vs tumor: what computed tomography radiomics of cardiac masses must show next.","authors":"Artur Dziewierz, Francesco Pelliccia","doi":"10.20452/pamw.17404","DOIUrl":"https://doi.org/10.20452/pamw.17404","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}